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John Rawls begins a Theory of Justice with the observation that 'Justice is the first virtue of social institutions, as truth is of systems of thought… Each person possesses an inviolability founded on justice that even the welfare of society as a whole cannot override'1 (p.3) buy water pills lasix. The hypertension medications lasix has resulted in lock-downs, the restriction of liberties, debate about the right to refuse medical treatment and many other changes to buy water pills lasix the everyday behaviour of persons. The justice issues it raises are diverse, profound and will demand our attention for some time.

How we can respect the Rawlsian commitment to the inviolability of each person, when the welfare of societies as a whole is under threat goes to the heart of some of the difficult ethical issues we face and are buy water pills lasix discussed in this issue of the Journal of Medical Ethics.The debate about ICU triage and hypertension medications is quite well developed and this journal has published several articles that explore aspects of this issue and how different places approach it.2–5 Newdick et al add to the legal analysis of triage decisions and criticise the calls for respecting a narrow conception of a legal right to treatment and more detailed national guidelines for how triage decisions should be made.6They consider scoring systems for clinical frailty, organ failure assessment, and raise some doubts about the fairness of their application to hypertension medications triage situations. Their argument seems to highlight instances of what is called the McNamara fallacy. US Secretary of Defense Robert McNamara used buy water pills lasix enemy body counts as a measure of military success during the Vietnam war.

So, the fallacy occurs when we rely solely on considerations that appear to be quantifiable, to the neglect of vital qualitative, difficult to measure or contestable features.6 Newdick et al point to variation in assessment, subtlety in condition and other factors as reasons why it is misleading to present scoring systems as ‘objective’ tests for triage. In doing so they draw a distinction between procedural and buy water pills lasix outcome consistency, which is important, and hints at distinctions Rawls drew between the different forms of procedural fairness. While we might hope to come up with a triage protocol that is procedurally fair and arrives at a fair outcome (what Rawls calls perfect procedural justice, p.

85) there buy water pills lasix is little prospect of that. As they observe, reasonable people can disagree about the outcomes we should aim for in allocating health resources and ICU triage for hypertension medications is no exception. Instead, we should work toward a buy water pills lasix transparent and fair process, what Rawls would describe as imperfect procedural justice (p.

85). His example of this is a criminal trial where we adopt processes that we have reason to believe are our best chance of determining guilt, but which do not guarantee the truth of a verdict, and this is a reason why they must be transparent and consistent (p. 85).

Their proposal is to triage patients into three broad categories. High, medium and low priority, with the thought that a range of considerations could feed into that evaluation by an appropriately constituted clinical group.Ballantyne et al question another issue that is central to the debate about hypertension medications triage.4 They describe how utility measures such as QALYs, lives saved seem to be in tension with equity. Their central point is that ICU for hypertension medications can be futile, and that is a reason for questioning how much weight should be given to equality of access to ICU for hypertension medications.

They claim that there is little point admitting someone to ICU when ICU is not in their best interests. Instead, the scope of equity should encompass preventing 'remediable differences among social, economic demographic or geographic groups' and for hypertension medications that means looking beyond access to ICU. Their central argument can be summarised as follows.Maximising utility can entrench existing health inequalities.The majority of those ventilated for hypertension medications in ICU will die.Admitting frailer or comorbid patients to ICU is likely to do more harm than good to these groups.Therefore, better access to ICU is unlikely to promote health equity for these groups.Equity for those with health inequalities related to hypertension medications should broadened to include all the services a system might provide.Brown et al argue in favour of hypertension medications immunity passports and the following summarises one of the key arguments in their article.7hypertension medications immunity passports are a way of demonstrating low personal and social risk.Those who are at low personal risk and low social risk from hypertension medications should be permitted more freedoms.Permitting those with immunity passports greater freedoms discriminates against those who do not have passports.Low personal and social risk and preserving health system capacity are relevant reasons to discriminate between those who have immunity and those who do not.Brown et al then consider a number of potential problems with immunity passports, many of which are justice issues.

Resentment by those who do not hold an immunity passport along with a loss of social cohesion, which is vital for responding to hypertension medications, are possible downsides. There is also the potential to advantage those who are immune, economically, and it could perpetuate existing inequalities. A significant objection, which is a problem for the justice of many policies, is free riding.

Some might create fraudulent immunity passports and it might even incentivise intentional exposure to the lasix. Brown et al suggest that disincentives and punishment are potential solutions and they are in good company as the Rawlsian solution to free riding is for 'law and government to correct the necessary corrections.' (p. 268)Elves and Herring focus on a set of ethical principles intended to guide those making policy and individual level decisions about adult social care delivery impacted by the lasix.8 They criticize the British government’s framework for being silent about what to do in the face of conflict between principles.

They suggest the dominant values in the framework are based on autonomy and individualism and argue that there are good reasons for not making autonomy paramount in policy about hypertension medications. These include that information about hypertension medications is incomplete, so no one can be that informed on decisions about their health. The second is one that highlights the importance of viewing our present ethical challenges via the lens of justice or other ethical concepts such as community or solidarity that enable us to frame collective obligations and interests.

They observe that hypertension medications has demonstrated how health and how we live our lives are linked. That what an individual does can have profound impact on the health of many others.Their view is that appeals to self-determination ring hollow for hypertension medications and their proposed remedy is one that pushes us to reflect on what the liberal commitment to the inviolability of each person means. They explain Dworkin’s account of 'associative obligations' which occur within a group when they acknowledge special rights and responsibilities to each other.

These obligations are a way of giving weight to community considerations, without collapsing into full-blown utilitarianism and while still respecting the inviolability of persons.The hypertension medications lasix is pushing ethical deliberation in new directions and many of them turn on approaching medical ethics with a greater emphasis on justice and related ethical concepts.IntroductionAs hypertension medications spread internationally, healthcare services in many countries became overwhelmed. One of the main manifestations of this was a shortage of intensive care beds, leading to urgent discussion about how to allocate these fairly. In the initial debates about allocation of scarce intensive care unit (ICU) resources, there was optimism about the ‘good’ of ICU access.

However, rather than being a life-saving intervention, data began to emerge in mid-April showing that most critical patients with hypertension medications who receive access to a ventilator do not survive to discharge. The minority who survive leave the ICU with significant morbidity and a long and uncertain road to recovery. This reality was under-recognised in bioethics debates about ICU triage throughout March and April 2020.

Central to these disucssions were two assumptions. First, that ICU admission was a valuable but scarce resource in the lasix context. And second, that both equity and utility considerations were important in determining which patients should have access to ICU.

In this paper we explain how scarcity and value were conflated in the early ICU hypertension medications triage literature, leading to undue optimism about the ‘good’ of ICU access, which in turned fuelled equity-based arguments for ICU access. In the process, ethical issues regarding equitable access to end-of-life care more broadly were neglected.Equity requires the prevention of avoidable or remediable differences among social, economic, demographic, or geographic groups.1 How best to apply an equity lens to questions of distribution will depend on the nature of the resource in question. Equitable distribution of ICU beds is significantly more complex than equitable distribution of other goods that might be scarce in a lasix, such as masks or treatments.

ICU (especially that which involves intubation and ventilation i.e. Mechanical ventilation) is a burdensome treatment option that can lead to significant suffering—both short and long term. The degree to which these burdens are justified depends on the probability of benefit, and this depends on the clinical status of the patient.

People are rightly concerned about the equity implications of excluding patients from ICU on the grounds of pre-existing comorbidities that directly affect prognosis, especially when these align with and reflect social disadvantage. But this does not mean that aged, frail or comorbid patients should be admitted to ICU on the grounds of equity, when this may not be in their best interests.ICU triage debateThe hypertension medications lasix generated extraordinary demand for critical care and required hard choices about who will receive presumed life-saving interventions such as ICU admission. The debate has focused on whether or not a utilitarian approach aimed at maximising the number of lives (or life-years) saved should be supplemented by equity considerations that attempt to protect the rights and interests of members of marginalised groups.

The utilitarian approach uses criteria for access to ICU that focus on capacity to benefit, understood as survival.2 Supplementary equity considerations have been invoked to relax the criteria in order to give a more diverse group of people a chance of entering ICU.3 4Equity-based critiques are grounded in the concern that a utilitarian approach aimed at maximising the number (or length) of lives saved may well exacerbate inequity in survival rates between groups. This potential for discrimination is heightened if triage tools use age as a proxy for capacity to benefit or are heavily reliant on Quality-Adjusted Life-Years (QALYs) which will deprioritise people with disabilities.5 6 Even if these pitfalls are avoided, policies based on maximising lives saved entrench existing heath inequalities because those most likely to benefit from treatment will be people of privilege who come into the lasix with better health status than less advantaged people. Those from lower socioeconomic groups, and/or some ethnic minorities have high rates of underlying comorbidities, some of which are prognostically relevant in hypertension medications .

Public health ethics requires that we acknowledge how apparently neutral triage tools reflect and reinforce these disparities, especially where the impact can be lethal.7But the utility versus equity debate is more complex than it first appears. Both the utility and equity approach to ICU triage start from the assumption that ICU is a valuable good—the dispute is about how best to allocate it. Casting ICU admission as a scarce good subject to rationing has the (presumably unintended) effect of making access to critical care look highly appealing, triggering cognitive biases.

Psychologists and marketers know that scarcity sells.8 People value a commodity more when it is difficult or impossible to obtain.9 When there is competition for scarce resources, people focus less on whether they really need or want the resource. The priority becomes securing access to the resource.Clinicians are not immune to scarcity-related cognitive bias. Clinicians treating patients with hypertension medications are working under conditions of significant information overload but without the high quality clinical research (generated from large data sets and rigorous methodology) usually available for decision-making.

The combination of overwhelming numbers of patients, high acuity and uncertainty regarding best practice is deeply anxiety provoking. In this context it is unsurprising that, at least in the early stages of the lasix, they may not have the psychological bandwidth to challenge assumptions about the benefits of ICU admission for patients with severe disease. Zagury-Orly and Schwartzstein have recently argued that the health sector must accept that doctors’ reasoning and decision-making are susceptible to human anxieties and in the “…effort to ‘do good’ for our patients, we may fall prey to cognitive biases and therapeutic errors”.10We suggest the global publicity and panic regarding ICU triage distorted assessments of best interests and decision-making about admittance to ICU and slanted ethical debate.

This has the potential to compromise important decisions with regard to care for patients with hypertension medications.The emerging reality of ICUIn general, the majority of patients who are ventilated for hypertension medications in ICU will die. Although comparing data from different health systems is challenging due to variation in admission criteria for ICU, clear trends are emerging with regard to those critically unwell and requiring mechanical ventilation. Emerging data show case fatality rates of 50%–88% for ventilated patients with hypertension medications.

In China11 and Italy about half of those with hypertension medications who receive ventilator support have not survived.12 In one small study in Wuhan the ICU mortality rate among those who received invasive mechanical ventilation was 86% (19/22).13 Interestingly, the rate among those who received less intensive non-invasive ventilation (NIV)1 was still 79% (23/29).13 Analysis of 5700 patients in the New York City area showed that the mortality for those receiving mechanical ventilation was 88%.14 In the UK, only 20% of those who have received mechanical ventilation have been discharged alive.15 Hence, the very real possibility of medical futility with regard to ventilation in hypertension medications needs to be considered.It is also important to consider the complications and side effects that occur in an ICU context. These patients are vulnerable to hospital acquired s such as ventilator associated pneumonias with high mortality rates in their own right,16 neuropathies, myopathies17 and skin damage. Significant long term morbidity (physical, mental and emotional challenges) can also be experienced by people who survive prolonged ventilation in ICU.12 18 Under normal (non-lasix) circumstances, many ICU patients experience significant muscle atrophy and deconditioning, sleep disorders, severe fatigue,19 post-traumatic stress disorder,20 cognitive deficits,21 depression, anxiety, difficulty with daily activities and loss of employment.22 Although it is too soon to have data on the long term outcomes of ICU survivors in the specific context of hypertension medications, the UK Chartered Society of Physiotherapy predicts a ‘tsunami of rehabilitation needs’ as patients with hypertension medications begin to be discharged.23 The indirect effects of carer-burden should also not be underestimated, as research shows that caring for patients who have survived critical illness results in high levels of depressive symptoms for the majority of caregivers.24The emerging mortality data for patients with hypertension medications admitted to ICU—in conjunction with what is already known about the morbidity of ICU survivors—has significant implications for the utility–equity debates about allocating the scarce resource of ICU beds.

First, they undermine the utility argument as there seems to be little evidence that ICU admission leads to better outcomes for patients, especially when the long term morbidity of extended ICU admission is included in the balance of burdens and benefits. For some patients, perhaps many, the burdens of ICU will not outweigh the limited potential benefits. Second, the poor survival rates challenge the equity-based claim for preferential access to treatment for members of disadvantaged groups.

In particular, admitting frailer or comorbid patients to ICU to fulfil equity goals is unlikely to achieve greater survival for these population groups, but will increase their risk of complications and may ultimately exacerbate or prolong their suffering.The high proportions of people who die despite ICU admission make it particularly important to consider what might constitute better or worse experiences of dying with hypertension medications, and how ICU admission affects the likelihood of a ‘good’ death. Critical care may compromise the ability of patients to communicate and engage with their families during the terminal phase of their lives—in the context of an intubated, ventilated patient this is unequivocal.Given the high rates of medical futility with patients with hypertension medications in ICU, the very significant risks for further suffering in the short and long term and the compromise of important psychosocial needs—such as communicating with our families—in the terminal phase of life, our ethical scope must be wider than ICU triage. Ho and Tsai argue that, “In considering effective and efficient allocation of healthcare resources as well as physical and psychological harm that can be incurred in prolonging the dying process, there is a critical need to reframe end-of-life care planning in the ICU.”25 We propose that the focus on equity concerns during the lasix should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care.

This requires attention to minimising barriers to accessing culturally safe care in the following interlinked areas. Palliative care, and communication and decision support and advanced care planning.Palliative careScaling up palliative and hospice care is an essential component of the hypertension medications lasix response. Avoiding non-beneficial or unwanted high-intensity care is critical when the capacity of the health system is stressed.26 Palliative care focuses on symptom management, quality of life and death, and holistic care of physical, psychological, social and spiritual health.27 Evidence from Italy has prompted recommendations that, “Governments must urgently recognise the essential contribution of hospice and palliative care to the hypertension medications lasix, and ensure these services are integrated into the healthcare system response.”28 Rapid palliative care policy changes were implemented in response to hypertension medications in Italy, including more support in community settings, change in admission criteria and daily telephone support for families.28 To meet this increased demand, hospice and palliative care staff should be included in personal protective equipment (PPE) allocation and provided with appropriate preventon and control training when dealing with patients with hypertension medications or high risk areas.Attention must also be directed to maintaining supply lines for essential medications for pain, distress and sedation.

Patients may experience pain due to existing comorbidities, but may also develop pain as a result of excessive coughing or immobility from hypertension medications. Such symptoms should be addressed using existing approaches to pain management.27 Supply lines for essential medications for distress and pain management, including fentanyl and midazolam are under threat in the USA and propofol—used in terminal sedation—may also be in short supply.29 The challenges are exacerbated when people who for various reasons eschew or are unable to secure hospital admission decline rapidly at home with hypertension medications (the time frame of recognition that someone is dying may be shorter than that through which hospice at home services usually support people). There is growing debate about the fair allocation of novel drugs—sometimes available as part of ongoing clinical trials—to treat hypertension medications with curative intent.2 30 But we must also pay attention to the fair allocation of drugs needed to ease suffering and dying.Communication and end-of-life decision-making supportEnd-of-life planning can be especially challenging because patients, family members and healthcare providers often differ in what they consider most important near the end of life.31 Less than half of ICU physicians—40.6% in high income countries and 46.3% in low–middle income countries—feel comfortable holding end-of-life discussions with patients’ families.25 With ICUs bursting and health providers under extraordinary pressure, their capacity to effectively support end-of-life decisions and to ease dying will be reduced.This suggests a need for specialist hypertension medications communication support teams, analogous to the idea of specialist ICU triage teams to ensure consistency of decision making about ICU admissions/discharges, and to reduce the moral and psychological distress of health providers during the lasix.32 These support teams could provide up to date information templates for patients and families, support decision-making, the development of advance care plans (ACPs) and act as a liaison between families (prevented from being in the hospital), the patient and the clinical team.

Some people with disabilities may require additional communication support to ensure the patients’ needs are communicated to all health providers.33 This will be especially important if carers and visitors are not able to be present.To provide effective and appropriate support in an equitable way, communication teams will need to include those with the appropriate skills for caring for diverse populations including. Interpreters, specialist social workers, disability advocates and cultural support liaison officers for ethnic and religious minorities. Patient groups that already have comparatively poor health outcomes require dedicated resources.

These support resources are essential if we wish to truly mitigate equity concerns that arisingduring the lasix context. See Box 1 for examples of specific communication and care strategies to support patients.Box 1 Supporting communication and compassionate care during hypertension medicationsDespite the sometimes overwhelming pressure of the lasix, health providers continue to invest in communication, compassionate care and end-of-life support. In some places, doctors have taken photos of their faces and taped these to the front of their PPE so that patients can ‘see’ their face.37 In Singapore, patients who test positive for hypertension are quarantined in health facilities until they receive two consecutive negative tests.

Patients may be isolated in hospital for several weeks. To help ease this burden on patients, health providers have dubbed themselves the ‘second family’ and gone out of their way to provide care as well as treatment. Elsewhere, medical, nursing and multi-disciplinary teams are utilising internet based devices to enable ‘virtual’ visits and contact between patients and their loved ones.38 Some centres are providing staff with masks with a see-through window panel that shows the wearer’s mouth, to support effective communication with patient with hearing loss who rely on lip reading.39Advance care planningACPs aim to honour decisions made by autonomous patients if and when they lose capacity.

However, talking to patients and their loved ones about clinical prognosis, ceilings of treatment and potential end-of-life care is challenging even in normal times. During hypertension medications the challenges are exacerbated by uncertainty and urgency, the absence of family support (due to visitor restrictions) and the wearing of PPE by clinicians and carers. Protective equipment can create a formidable barrier between the patient and the provider, often adding to the patient’s sense of isolation and fear.

An Australian palliative care researcher with experience working in disaster zones, argues that the “PPE may disguise countenance, restrict normal human touch and create an unfamiliar gulf between you and your patient.”34 The physical and psychological barriers of PPE coupled with the pressure of high clinical loads do not seem conducive to compassionate discussions about patients’ end-of-life preferences. Indeed, a study in Singapore during the 2004 SARS epidemic demonstrated the barrier posed by PPE to compassionate end-of-life care.35Clinicians may struggle to interpret existing ACPs in the context of hypertension medications, given the unprecedented nature and scale of the lasix and emerging clinical knowledge about the aetiology of the disease and (perhaps especially) about prognosis. This suggests the need for hypertension medications-specific ACPs.

Where possible, proactive planning should occur with high-risk patients, the frail, those in residential care and those with significant underlying morbidities. Ideally, ACP conversations should take place prior to illness, involve known health providers and carers, not be hampered by PPE or subject to time constraints imposed by acute care contexts. Of note here, a systematic review found that patients who received advance care planning or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU length of stay.36ConclusionHow best to address equity concerns in relation to ICU and end-of-life care for patients with hypertension medications is challenging and complex.

Attempts to broaden clinical criteria to give patients with poorer prognoses access to ICU on equity grounds may result in fewer lives saved overall—this may well be justified if access to ICU confers benefit to these ‘equity’ patients. But we must avoid tokenistic gestures to equity—admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. ICU admission may exacerbate and prolong suffering rather than ameliorate it, especially for frailer patients.

And prolonging life at all costs may ultimately lead to a worse death. The capacity for harm not just the capacity for benefit should be emphasised in any triage tools and related literature. Equity can be addressed more robustly if lasix responses scale up investment in palliative care services, communication and decision-support services and advanced care planning to meet the needs of all patients with hypertension medications.

Ultimately, however, equity considerations will require us to move even further from a critical care framework as the social and economic impact of the lasix will disproportionately impact those most vulnerable. Globally, we will need an approach that does not just stop an exponential rise in s but an exponential rise in inequality.AcknowledgmentsWe would like to thank Tracy Anne Dunbrook and David Tripp for their helpful comments, and NUS Medicine for permission to reproduce the hypertension medications Chronicles strip..

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The hypertension medications lasix continues to negatively impact population health by indirect effects on patient and healthcare systems, in addition lasix drip to the direct effects of hypertension medications itself. Accurate and quantitative information about the indirect effects of the hypertension medications lasix on cardiovascular disease (CVD) services and outcomes will allow better public health planning. Ball and colleagues1 aim to ‘design and implement a simple tool for monitoring and visualising trends in CVD hospital services in the UK’ and towards that end they present pilot data from a preliminary cohort of nine UK hospitals in this issue of Heart lasix drip. Comparing 6 months in 2019–2020 (that include the hypertension medications lockdown in the UK) to the same time period in 2018–2019, there was a 57.9% decrease in total hospital admissions and a 52.9% decrease in emergency department visits (figure 1). In addition, there was a 31%–88% decline during lockdown in procedures for treatment of cardiac, cerebrovascular and other vascular conditions.Overall hospital activity (admissions, ED attendances and hypertension medications admissions) between 31 October 2019 and 10 May 2020 compared with the same weeks from 2018 to 2019.

Lines describe the mean hospital activities in 2019–2020 lasix drip (solid) and 2018–2019 (dotted). Shading represents 95% CI of the respective hospital activity. The first case of hypertension medications was on 31 January 2020 and lockdown started on 23 March 2020. ED, emergency department." data-icon-position data-hide-link-title="0">Figure 1 Overall hospital activity (admissions, ED attendances and hypertension medications admissions) between 31 lasix drip October 2019 and 10 May 2020 compared with the same weeks from 2018 to 2019. Lines describe the mean hospital activities in 2019–2020 (solid) and 2018–2019 (dotted).

Shading represents 95% CI of the respective hospital activity. The first case of hypertension medications was on 31 January 2020 and lasix drip lockdown started on 23 March 2020. ED, emergency department.From the other side of the world, Brant and colleagues2 report the number of cardiovascular deaths in the six Brazilian cities with the greatest number of hypertension medications deaths. They conclude. €˜Excess cardiovascular mortality was greater in the lasix drip less developed cities, possibly associated with healthcare collapse.

Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis. Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse’ (figure 2).Per cent change with 95% CIs between the observed and expected number of deaths in 2020 for specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular diseases per selected six capital cities." data-icon-position data-hide-link-title="0">Figure 2 Per cent change with 95% CIs between the observed and expected number of deaths in 2020 for specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular diseases per selected six capital cities.In the accompanying editorial, Watkins3 notes that ‘Taken together, these two studies quantify what many readers of this journal have experienced firsthand. The restructuring of hospital services to cope with an influx of hypertension medications cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.’ He then goes lasix drip on to propose policy responses to reduce all-cause death among patients with CVD including deaths due to hypertension medications or to disruptions to healthcare delivery associated with the lasix (figure 3). His two key messages are. (1) ‘the global and national lasix responses cannot be separated from the cardiovascular health agenda’ and (2) ‘priorities for cardiovascular science must pivot, capitalising on lessons learnt during the lasix’.Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications.

The elements proposed above can be modified to fit the resource levels and epidemiological contexts lasix drip of different countries. Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality." data-icon-position data-hide-link-title="0">Figure 3 Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts of lasix drip different countries. Areas marked in red are those likely to translate into the largest short-term mortality gains.

Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality.Other interesting papers in this issue of Heart include a study by Doris and colleagues4 showing that in adults with aortic stenosis CT quantitation of valve calcification is reproducible and demonstrates a greater rate of change in disease severity, compared with echocardiography. Guzzetti and lasix drip Clavel5 point out that more precise measures of aortic stenosis (AS) severity will allow smaller sample sizes in clinical trials of potential medical therapies, in addition to providing insights into the pathophysiology of disease progression (figure 4).Model of AS progression. Pathophysiological model of serial AS progression (‘aortic stenosis cascade’, in blue), along with imaging biomarkers targeting each phase (red) and potential disease-modifying treatments being currently tested in randomised clinical trials (green). 1South Korean PCSK9 inhibitors (NCT03051360). 2EAVaLL.

Early aortic valve lipoprotein(a) lowering (NCT02109614). 3SALTIRE II. Study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis (NCT02132026). 4BASIK2. Bicuspid aortic valve stenosis and the effect of vitamin K2 on calcium metabolism on 18F-NaF PET/MRI (NCT02917525).

5EvoLVeD. Early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe AS (NCT03094143). 6Early TAVR. Evaluation of transcatheter aortic valve replacement compared with surveillance for patients with asymptomatic severe aortic stenosis (NCT03042104). 18F-FDG, 18-fluorodeoxyglucose.

18F-NaF, 18-sodium fluoride. AS, aortic stenosis. AVC, aortic valve calcification. PET, positron emission tomography. PCSK9, proprotein convertase subtilisin/kexin type 9.

TAVR, transcatheter aortic valve replacement." data-icon-position data-hide-link-title="0">Figure 4 Model of AS progression. Pathophysiological model of serial AS progression (‘aortic stenosis cascade’, in blue), along with imaging biomarkers targeting each phase (red) and potential disease-modifying treatments being currently tested in randomised clinical trials (green). 1South Korean PCSK9 inhibitors (NCT03051360). 2EAVaLL. Early aortic valve lipoprotein(a) lowering (NCT02109614).

3SALTIRE II. Study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis (NCT02132026). 4BASIK2. Bicuspid aortic valve stenosis and the effect of vitamin K2 on calcium metabolism on 18F-NaF PET/MRI (NCT02917525). 5EvoLVeD.

Early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe AS (NCT03094143). 6Early TAVR. Evaluation of transcatheter aortic valve replacement compared with surveillance for patients with asymptomatic severe aortic stenosis (NCT03042104). 18F-FDG, 18-fluorodeoxyglucose. 18F-NaF, 18-sodium fluoride.

AS, aortic stenosis. AVC, aortic valve calcification. PET, positron emission tomography. PCSK9, proprotein convertase subtilisin/kexin type 9. TAVR, transcatheter aortic valve replacement.In a study of patients undergoing atrial fibrillation (AF) ablation, Piccini and colleagues6 found that almost 30% experienced recurrent atrial tachycardiac (AT) or AF within 3 months.

However, although those without recurrent AT/AF had greater improvement in functional status, overall quality of life was similar in those with and without AT/AF recurrence. Sridhar and Colbert7 discuss the importance of patient-reported outcomes (PROs), not just ‘hard’ clinical endpoints in clinical trials. €˜As researchers and clinicians, our goals must align with those of the patients and what they value. It is heartening to see that more and more clinical trials in cardiology and electrophysiology are incorporating PROs as important endpoints. A slow but definite paradigm shift is occurring to incorporate therapies with a focus on improving patients’ lives, not just their hearts.’The Education in Heart article in this issue discusses the diagnosis and management of familial hypercholesterolemia.8 Our Cardiology in Focus article ‘What to do when things go wrong’ provides a thoughtful discussion of the key steps in dealing with medical error.9 The Image Challenge in this issue10 provides a concise review of a sophisticated set of possible diagnoses to consider in a patient with a new murmur and classic echocardiographic images.

Be sure to look at our online Image Challenge archive with over 150 image-based multiple choice questions and answers (https://heart.bmj.com/pages/collections/image_challenges/).Global trends in cardiovascular health have reached a worrisome inflection point. Decades of innovation led to a slew of drugs, devices and programmes that translated into reduced mortality from cardiovascular diseases in many countries. Unfortunately, progress on cardiovascular mortality since 2010 has slowed. In some countries, it has even reversed.1 Compounding the problem, political actions on cardiovascular health have been inadequate, and health systems across many low-income and middle-income countries are woefully under-resourced to scale up basic cardiovascular services. These factors could increase global health inequalities in coming decades.2hypertension medications threatens to derail progress on cardiovascular health even furtherCardiovascular practitioners are now under greater pressure to deliver the same or better care in the context of a lasix.

hypertension medications has hit cardiovascular care particularly hard. WHO surveys recently found that cardiovascular services have been partially or completely disrupted in nearly half of countries with community spread of hypertension medications, raising the chance of increased cardiovascular mortality in these locations.3Two studies published in this issue of Heart shed more light on the specific effects of hypertension medications on health systems in Brazil and the UK. Brant et al looked at cardiovascular mortality in six Brazilian capital cities.4 Ball et al tracked disruptions in acute cardiovascular services across nine UK hospitals.5 Taken together, these two studies quantify what many readers of this Journal have experienced firsthand. The restructuring of hospital services to cope with an influx of hypertension medications cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.Although Ball et al did not attempt to link reduced service delivery to mortality outcomes, other studies from the UK have estimated excess cardiovascular deaths during hypertension medications.5 Brant et al posited that excess cardiovascular mortality in Brazil was partly due to avoidance of care (ie, increases cardiovascular deaths occurring at home).4 They also found that healthcare system collapse in more socioeconomically deprived states was associated with increased acute coronary syndrome and stroke deaths in these states, independent of the uptick in deaths at home.A comprehensive responseWhat can be done about these disruptions?. The relationship between hypertension medications and cardiovascular health can be separated into two issues that require different responses.

First, persons living with cardiovascular diseases have worse outcomes when they acquire hypertension medications. On the other hand, persons living with cardiovascular disease or major risk factors are also at increased risk of death from cardiovascular mechanisms (eg, thrombotic events or heart failure) when their access to acute care services is interrupted. Health systems, patients and patient-system interactions are implicated in both of these issues.Figure 1 illustrates how an appropriate policy response should consider all of the elements mentioned above, with the overarching goal being to reduce deaths from any cause (hypertension medications or otherwise) among persons living with cardiovascular diseases or major risk factors. Importantly, the actions specified in the figure 1 can be adapted to all populations and countries, regardless of health system resource levels. With such a framework in mind, practitioners and researchers could then structure their work and advocacy around two key messages.Message 1.

The global and national lasix responses cannot be separated from the cardiovascular health agendaCritical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts of different countries. Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality." data-icon-position data-hide-link-title="0">Figure 1 Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts of different countries.

Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality.Outcomes from infectious diseases are usually worse among patients with multimorbidity, and hypertension medications is no different. As cardiovascular practitioners, scientists and advocates, we need to articulate the substantial benefits of lasix mitigation efforts to persons living with cardiovascular diseases or risk factors. In parallel, accelerated investment in population-level prevention efforts would reduce the future burden of cardiovascular disease on health systems and reduce the number of persons at high risk of complications from future lasixs or outbreaks.In much of the global health community, investments in acute care and in cardiovascular diseases are often perceived to be non-essential—or even anti-equity—and are almost never given serious consideration within health and development programmes. We need to forcefully push back on such short-sighted thinking.

Collaborators on the Disease Control Priorities Project recently released guidance for low-income and middle-income and humanitarian settings, including a list of 120 essential health services to protect during the lasix. On value-for-money grounds, basic cardiovascular disease prevention and care are just as ‘essential’ as immunisation programmes, maternal healthcare and screening and treatment of HIV .6At the same time, locations with advanced cardiovascular care systems need guidance on how to balance the need to treat severe cardiovascular disease against the need to adapt quickly to increased hypertension medications caseloads. Ball et al found that emergency department visits and percutaneous coronary intervention procedure rates in UK hospitals had partially rebounded by the end of May 2020.5 Assuming the top objective is to maximise health, emergency cardiac care and interventional services should be brought back online before phasing in other semi-elective vascular procedures (even if the latter provide substantial revenues to hospitals). Critically, more must be done to encourage patients with acute cardiac or neurological symptoms to seek care even in the face of potential hypertension medications exposure. Initiatives like the American Heart Association’s ‘Don’t Die of Doubt’ campaign7 should be examined, adapted and disseminated widely to complement supply-side efforts to improve access.Message 2.

Priorities for cardiovascular science must pivot, capitalising on lessons learnt during the lasixIt is increasingly clear that lasixs and emerging s, driven by globalisation and climate change, will continue to threaten health systems in the coming decades. Cardiovascular research and development priorities must adapt to this emerging reality. We need new technologies, programmes and care systems that protect what is working during hypertension medications and transform what is not. In addition, the lasix has illuminated—and in many cases magnified—inequalities in cardiovascular health. Cardiovascular research funders should prioritise development of truly ‘global’ public goods that can immediately benefit the health of the world’s poorest as well as vulnerable populations in the global North.2How could the cardiovascular research community make this pivot?.

Table 1 proposes several principles for cardiovascular research and development priorities amid and beyond the hypertension medications lasix. Not every concept in table 1 will be directly applicable to every research initiative, but they could be used by funders as benchmarks for developing or revising their strategies and scoring proposals.View this table:Table 1 Proposed principles to guide cardiovascular research and development prioritiesManagement of acute coronary syndromes exemplifies the need for a research and development pivot. Our ability to reduce case fatality from acute coronary syndromes is based on prompt delivery of interventions or fibrinolysis. Researchers and planners have worked for years to improve referral and triage systems to increase access to these life-saving technologies. Yet when viewed through the lens of hypertension medications, it is problematic that the cornerstone of acute coronary syndrome management is early access to a referral hospital.

We need new technologies, like home-based diagnostics and smartphone-based triage and referral processes, that can circumvent time and distance bottlenecks. We also need new drugs (available at home) that bridge to interventions or replace them entirely. Such technologies are especially needed in low-income and middle-income countries, where systems are less advanced and timely access is more difficult to achieve (eg, in majority-rural countries).More generally, new technologies should ‘disrupt’ care systems in a way that makes cardiovascular care more patient-centred, community-facing and responsive to population needs. The notion that healthcare by default requires a physical building (separate from one’s home or work) should quickly become antiquated. The greater use of telemedicine during the lasix is a big step in this direction, but we have yet to hardness the full potential of mobile devices and wearables—technologies that are already widely available and will become ubiquitous in low-income and middle-income countries much more quickly than new clinics or hospitals.

Innovators and health planners in resource-limited countries could collaborate to develop ‘leapfrog’ cardiovascular health programmes that do not rely on the inefficient, slow-to-adapt and labour-intensive models used in the global North.The future of cardiovascular health and researchIn the midst of the debate over the future of cardiovascular care, we should not to lose sight of the ‘endgame’.8 In the long term, it would be far better to live in a world where the prevalence of ideal cardiovascular health is high and the lifetime disease risk is low. In such a world, the impact of another lasix on cardiovascular services and patients would be lessened greatly. Aggressive action is needed to fully implement policies and health services that we know can help achieve this goal in a cost-effective manner. Still, in order to accomplish the endgame, we need better evidence on how to design policy instruments that can minimise dietary risks and barriers to optimal physical activity—the most challenging of the risk factors to tackle.2hypertension medications has left an indelible mark on human health. At the end of 2019, many of us in the cardiovascular health community were probably quite comfortable with business as usual and with incremental improvements in science and clinical practice.

The events of 2020 have raised the stakes, forcing us to become more accepting of disruptions (creative or otherwise). We must use this opportunity to think more boldly..

The hypertension medications lasix continues to negatively impact population health by indirect effects on patient and healthcare systems, in addition to the buy water pills lasix direct effects of hypertension medications itself. Accurate and quantitative information about the indirect effects of the hypertension medications lasix on cardiovascular disease (CVD) services and outcomes will allow better public health planning. Ball and colleagues1 aim to ‘design and implement a simple tool for monitoring and visualising trends in CVD hospital services in the UK’ and buy water pills lasix towards that end they present pilot data from a preliminary cohort of nine UK hospitals in this issue of Heart. Comparing 6 months in 2019–2020 (that include the hypertension medications lockdown in the UK) to the same time period in 2018–2019, there was a 57.9% decrease in total hospital admissions and a 52.9% decrease in emergency department visits (figure 1).

In addition, there was a 31%–88% decline during lockdown in procedures for treatment of cardiac, cerebrovascular and other vascular conditions.Overall hospital activity (admissions, ED attendances and hypertension medications admissions) between 31 October 2019 and 10 May 2020 compared with the same weeks from 2018 to 2019. Lines describe the mean hospital activities buy water pills lasix in 2019–2020 (solid) and 2018–2019 (dotted). Shading represents 95% CI of the respective hospital activity. The first case of hypertension medications was on 31 January 2020 and lockdown started on 23 March 2020.

ED, emergency department." data-icon-position buy water pills lasix data-hide-link-title="0">Figure 1 Overall hospital activity (admissions, ED attendances and hypertension medications admissions) between 31 October 2019 and 10 May 2020 compared with the same weeks from 2018 to 2019. Lines describe the mean hospital activities in 2019–2020 (solid) and 2018–2019 (dotted). Shading represents 95% CI of the respective hospital activity. The first case of hypertension medications was buy water pills lasix on 31 January 2020 and lockdown started on 23 March 2020.

ED, emergency department.From the other side of the world, Brant and colleagues2 report the number of cardiovascular deaths in the six Brazilian cities with the greatest number of hypertension medications deaths. They conclude. €˜Excess cardiovascular mortality was greater in the less developed cities, possibly associated with healthcare buy water pills lasix collapse. Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis.

Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse’ (figure 2).Per cent change with 95% CIs between the observed and expected number of deaths in 2020 for specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular diseases per selected six capital cities." data-icon-position data-hide-link-title="0">Figure 2 Per cent change with 95% CIs between the observed and expected number of deaths in 2020 for specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular diseases per selected six capital cities.In the accompanying editorial, Watkins3 notes that ‘Taken together, these two studies quantify what many readers of this journal have experienced firsthand. The restructuring of hospital services to buy water pills lasix cope with an influx of hypertension medications cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.’ He then goes on to propose policy responses to reduce all-cause death among patients with CVD including deaths due to hypertension medications or to disruptions to healthcare delivery associated with the lasix (figure 3). His two key messages are. (1) ‘the global and national lasix responses cannot be separated from the cardiovascular health agenda’ and (2) ‘priorities for cardiovascular science must pivot, capitalising on lessons learnt during the lasix’.Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications.

The elements proposed above can be buy water pills lasix modified to fit the resource levels and epidemiological contexts of different countries. Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality." data-icon-position data-hide-link-title="0">Figure 3 Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be buy water pills lasix modified to fit the resource levels and epidemiological contexts of different countries.

Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality.Other interesting papers in this issue of Heart include a study by Doris and colleagues4 showing that in adults with aortic stenosis CT quantitation of valve calcification is reproducible and demonstrates a greater rate of change in disease severity, compared with echocardiography. Guzzetti and Clavel5 point out that more precise measures of aortic stenosis (AS) severity will allow smaller sample sizes in clinical trials of potential medical therapies, in addition to providing insights into buy water pills lasix the pathophysiology of disease progression (figure 4).Model of AS progression. Pathophysiological model of serial AS progression (‘aortic stenosis cascade’, in blue), along with imaging biomarkers targeting each phase (red) and potential disease-modifying treatments being currently tested in randomised clinical trials (green).

1South Korean PCSK9 inhibitors (NCT03051360). 2EAVaLL. Early aortic valve lipoprotein(a) lowering (NCT02109614). 3SALTIRE II.

Study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis (NCT02132026). 4BASIK2. Bicuspid aortic valve stenosis and the effect of vitamin K2 on calcium metabolism on 18F-NaF PET/MRI (NCT02917525). 5EvoLVeD.

Early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe AS (NCT03094143). 6Early TAVR. Evaluation of transcatheter aortic valve replacement compared with surveillance for patients with asymptomatic severe aortic stenosis (NCT03042104). 18F-FDG, 18-fluorodeoxyglucose.

18F-NaF, 18-sodium fluoride. AS, aortic stenosis. AVC, aortic valve calcification. PET, positron emission tomography.

PCSK9, proprotein convertase subtilisin/kexin type 9. TAVR, transcatheter aortic valve replacement." data-icon-position data-hide-link-title="0">Figure 4 Model of AS progression. Pathophysiological model of serial AS progression (‘aortic stenosis cascade’, in blue), along with imaging biomarkers targeting each phase (red) and potential disease-modifying treatments being currently tested in randomised clinical trials (green). 1South Korean PCSK9 inhibitors (NCT03051360).

2EAVaLL. Early aortic valve lipoprotein(a) lowering (NCT02109614). 3SALTIRE II. Study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis (NCT02132026).

4BASIK2. Bicuspid aortic valve stenosis and the effect of vitamin K2 on calcium metabolism on 18F-NaF PET/MRI (NCT02917525). 5EvoLVeD. Early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe AS (NCT03094143).

6Early TAVR. Evaluation of transcatheter aortic valve replacement compared with surveillance for patients with asymptomatic severe aortic stenosis (NCT03042104). 18F-FDG, 18-fluorodeoxyglucose. 18F-NaF, 18-sodium fluoride.

AS, aortic stenosis. AVC, aortic valve calcification. PET, positron emission tomography. PCSK9, proprotein convertase subtilisin/kexin type 9.

TAVR, transcatheter aortic valve replacement.In a study of patients undergoing atrial fibrillation (AF) ablation, Piccini and colleagues6 found that almost 30% experienced recurrent atrial tachycardiac (AT) or AF within 3 months. However, although those without recurrent AT/AF had greater improvement in functional status, overall quality of life was similar in those with and without AT/AF recurrence. Sridhar and Colbert7 discuss the importance of patient-reported outcomes (PROs), not just ‘hard’ clinical endpoints in clinical trials. €˜As researchers and clinicians, our goals must align with those of the patients and what they value.

It is heartening to see that more and more clinical trials in cardiology and electrophysiology are incorporating PROs as important endpoints. A slow but definite paradigm shift is occurring to incorporate therapies with a focus on improving patients’ lives, not just their hearts.’The Education in Heart article in this issue discusses the diagnosis and management of familial hypercholesterolemia.8 Our Cardiology in Focus article ‘What to do when things go wrong’ provides a thoughtful discussion of the key steps in dealing with medical error.9 The Image Challenge in this issue10 provides a concise review of a sophisticated set of possible diagnoses to consider in a patient with a new murmur and classic echocardiographic images. Be sure to look at our online Image Challenge archive with over 150 image-based multiple choice questions and answers (https://heart.bmj.com/pages/collections/image_challenges/).Global trends in cardiovascular health have reached a worrisome inflection point. Decades of innovation led to a slew of drugs, devices and programmes that translated into reduced mortality from cardiovascular diseases in many countries.

Unfortunately, progress on cardiovascular mortality since 2010 has slowed. In some countries, it has even reversed.1 Compounding the problem, political actions on cardiovascular health have been inadequate, and health systems across many low-income and middle-income countries are woefully under-resourced to scale up basic cardiovascular services. These factors could increase global health inequalities in coming decades.2hypertension medications threatens to derail progress on cardiovascular health even furtherCardiovascular practitioners are now under greater pressure to deliver the same or better care in the context of a lasix. hypertension medications has hit cardiovascular care particularly hard.

WHO surveys recently found that cardiovascular services have been partially or completely disrupted in nearly half of countries with community spread of hypertension medications, raising the chance of increased cardiovascular mortality in these locations.3Two studies published in this issue of Heart shed more light on the specific effects of hypertension medications on health systems in Brazil and the UK. Brant et al looked at cardiovascular mortality in six Brazilian capital cities.4 Ball et al tracked disruptions in acute cardiovascular services across nine UK hospitals.5 Taken together, these two studies quantify what many readers of this Journal have experienced firsthand. The restructuring of hospital services to cope with an influx of hypertension medications cases, combined with social distancing measures, has severely limited access to cardiovascular care, adversely impacting patient outcomes.Although Ball et al did not attempt to link reduced service delivery to mortality outcomes, other studies from the UK have estimated excess cardiovascular deaths during hypertension medications.5 Brant et al posited that excess cardiovascular mortality in Brazil was partly due to avoidance of care (ie, increases cardiovascular deaths occurring at home).4 They also found that healthcare system collapse in more socioeconomically deprived states was associated with increased acute coronary syndrome and stroke deaths in these states, independent of the uptick in deaths at home.A comprehensive responseWhat can be done about these disruptions?. The relationship between hypertension medications and cardiovascular health can be separated into two issues that require different responses.

First, persons living with cardiovascular diseases have worse outcomes when they acquire hypertension medications. On the other hand, persons living with cardiovascular disease or major risk factors are also at increased risk of death from cardiovascular mechanisms (eg, thrombotic events or heart failure) when their access to acute care services is interrupted. Health systems, patients and patient-system interactions are implicated in both of these issues.Figure 1 illustrates how an appropriate policy response should consider all of the elements mentioned above, with the overarching goal being to reduce deaths from any cause (hypertension medications or otherwise) among persons living with cardiovascular diseases or major risk factors. Importantly, the actions specified in the figure 1 can be adapted to all populations and countries, regardless of health system resource levels.

With such a framework in mind, practitioners and researchers could then structure their work and advocacy around two key messages.Message 1. The global and national lasix responses cannot be separated from the cardiovascular health agendaCritical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts of different countries. Areas marked in red are those likely to translate into the largest short-term mortality gains.

Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality." data-icon-position data-hide-link-title="0">Figure 1 Critical elements of a comprehensive policy response to cardiovascular disease during hypertension medications. The elements proposed above can be modified to fit the resource levels and epidemiological contexts of different countries. Areas marked in red are those likely to translate into the largest short-term mortality gains. Areas marked in yellow or green, while important for prevention, health promotion or stewardship objectives, are less likely to reduce mortality.Outcomes from infectious diseases are usually worse among patients with multimorbidity, and hypertension medications is no different.

As cardiovascular practitioners, scientists and advocates, we need to articulate the substantial benefits of lasix mitigation efforts to persons living with cardiovascular diseases or risk factors. In parallel, accelerated investment in population-level prevention efforts would reduce the future burden of cardiovascular disease on health systems and reduce the number of persons at high risk of complications from future lasixs or outbreaks.In much of the global health community, investments in acute care and in cardiovascular diseases are often perceived to be non-essential—or even anti-equity—and are almost never given serious consideration within health and development programmes. We need to forcefully push back on such short-sighted thinking. Collaborators on the Disease Control Priorities Project recently released guidance for low-income and middle-income and humanitarian settings, including a list of 120 essential health services to protect during the lasix.

On value-for-money grounds, basic cardiovascular disease prevention and care are just as ‘essential’ as immunisation programmes, maternal healthcare and screening and treatment of HIV .6At the same time, locations with advanced cardiovascular care systems need guidance on how to balance the need to treat severe cardiovascular disease against the need to adapt quickly to increased hypertension medications caseloads. Ball et al found that emergency department visits and percutaneous coronary intervention procedure rates in UK hospitals had partially rebounded by the end of May 2020.5 Assuming the top objective is to maximise health, emergency cardiac care and interventional services should be brought back online before phasing in other semi-elective vascular procedures (even if the latter provide substantial revenues to hospitals). Critically, more must be done to encourage patients with acute cardiac or neurological symptoms to seek care even in the face of potential hypertension medications exposure. Initiatives like the American Heart Association’s ‘Don’t Die of Doubt’ campaign7 should be examined, adapted and disseminated widely to complement supply-side efforts to improve access.Message 2.

Priorities for cardiovascular science must pivot, capitalising on lessons learnt during the lasixIt is increasingly clear that lasixs and emerging s, driven by globalisation and climate change, will continue to threaten health systems in the coming decades. Cardiovascular research and development priorities must adapt to this emerging reality. We need new technologies, programmes and care systems that protect what is working during hypertension medications and transform what is not. In addition, the lasix has illuminated—and in many cases magnified—inequalities in cardiovascular health.

Cardiovascular research funders should prioritise development of truly ‘global’ public goods that can immediately benefit the health of the world’s poorest as well as vulnerable populations in the global North.2How could the cardiovascular research community make this pivot?. Table 1 proposes several principles for cardiovascular research and development priorities amid and beyond the hypertension medications lasix. Not every concept in table 1 will be directly applicable to every research initiative, but they could be used by funders as benchmarks for developing or revising their strategies and scoring proposals.View this table:Table 1 Proposed principles to guide cardiovascular research and development prioritiesManagement of acute coronary syndromes exemplifies the need for a research and development pivot. Our ability to reduce case fatality from acute coronary syndromes is based on prompt delivery of interventions or fibrinolysis.

Researchers and planners have worked for years to improve referral and triage systems to increase access to these life-saving technologies. Yet when viewed through the lens of hypertension medications, it is problematic that the cornerstone of acute coronary syndrome management is early access to a referral hospital. We need new technologies, like home-based diagnostics and smartphone-based triage and referral processes, that can circumvent time and distance bottlenecks. We also need new drugs (available at home) that bridge to interventions or replace them entirely.

Such technologies are especially needed in low-income and middle-income countries, where systems are less advanced and timely access is more difficult to achieve (eg, in majority-rural countries).More generally, new technologies should ‘disrupt’ care systems in a way that makes cardiovascular care more patient-centred, community-facing and responsive to population needs. The notion that healthcare by default requires a physical building (separate from one’s home or work) should quickly become antiquated. The greater use of telemedicine during the lasix is a big step in this direction, but we have yet to hardness the full potential of mobile devices and wearables—technologies that are already widely available and will become ubiquitous in low-income and middle-income countries much more quickly than new clinics or hospitals. Innovators and health planners in resource-limited countries could collaborate to develop ‘leapfrog’ cardiovascular health programmes that do not rely on the inefficient, slow-to-adapt and labour-intensive models used in the global North.The future of cardiovascular health and researchIn the midst of the debate over the future of cardiovascular care, we should not to lose sight of the ‘endgame’.8 In the long term, it would be far better to live in a world where the prevalence of ideal cardiovascular health is high and the lifetime disease risk is low.

In such a world, the impact of another lasix on cardiovascular services and patients would be lessened greatly. Aggressive action is needed to fully implement policies and health services that we know can help achieve this goal in a cost-effective manner. Still, in order to accomplish the endgame, we need better evidence on how to design policy instruments that can minimise dietary risks and barriers to optimal physical activity—the most challenging of the risk factors to tackle.2hypertension medications has left an indelible mark on human health. At the end of 2019, many of us in the cardiovascular health community were probably quite comfortable with business as usual and with incremental improvements in science and clinical practice.

The events of 2020 have raised the stakes, forcing us to become more accepting of disruptions (creative or otherwise). We must use this opportunity to think more boldly..

What should I watch for while using Lasix?

Visit your doctor or health care professional for regular checks on your progress. Check your blood pressure regularly. Ask your doctor or health care professional what your blood pressure should be, and when you should contact him or her. If you are a diabetic, check your blood sugar as directed.

You may need to be on a special diet while taking Lasix. Check with your doctor. Also, ask how many glasses of fluid you need to drink a day. You must not get dehydrated.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this drug affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol can make you more drowsy and dizzy. Avoid alcoholic drinks.

Lasix can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

Furosemide lasix

Paul Berg, M.D.While hypertension medications has caused significant illness and concern for millions of lasix 40mg tablet pricelasix order Americans and residents across the globe, experts at MidMichigan Health remind us not to furosemide lasix lose sight of another potentially lethal lasix - Influenza.Influenza is a seasonal lasix that impacts the U.S. Population each year between late fall and early spring. Since 2015, influenza has furosemide lasix caused between 280,000 to 810,000 hospitalizations each year in the U.S., and 23,000 to 61,000 Americans have died from the lasix. Fortunately, influenza is a preventable illness because of the annual flu treatment. However, only about half of the furosemide lasix U.S.

Population receives the flu treatment each year. Paul Berg furosemide lasix M.D., president, MidMichigan Physicians Group. Courtney Pearson, M.D., infectious disease specialist, MidMichigan Physicians Group, and Lydia Watson, M.D., senior vice president and chief medical officer, MidMichigan Health, answer some of the common questions about the flu treatment:Courtney Pearson, M.D.How does the flu treatment work?. The flu treatment works by causing antibodies to form furosemide lasix in the human body. These antibodies provide protection against if that individual is later exposed to the actual lasix.

treatments in furosemide lasix the U.S. Protect against three (“trivalent”) or four (“quadrivalent”) different strains of the flu lasix. Once the flu treatment is administered, it takes about two weeks furosemide lasix for the body to generate the protective antibodies. These antibodies then provide protection for several months following the vaccination. The best time to receive the flu vaccination is in the fall, prior furosemide lasix to the arrival of the seasonal lasix.

Most medical providers begin administering the treatment in September but will continue to administer for the duration of the flu season. The Centers for Disease Control and Prevention (CDC) recommends that furosemide lasix people get a flu treatment by the end of October.Who should be vaccinated?. With rare exception, every human older than 6 months of age should receive the flu treatment each year. Some people may not be candidates for certain treatment types, dependent on factors such as age, allergy furosemide lasix history, or underlying medical conditions, so these individuals should check with their medical provider to discuss which treatment may be best for them. However, the most important fact to remember is to receive the treatment each year.Lydia Watson, M.D.Does the flu treatment really work?.

Yes. The treatment is effective, though the effectiveness can vary based on certain factors. The protection from the treatment varies from season to season dependent on the “match” between the treatment and the actual lasixes circulating in the community. An individual’s health status can also play a role in the effectiveness of the treatment. In general, the treatment is most effective in young, healthy adults and older children.

Older adults may not mount as robust an antibody response to the treatment. Even though it is not perfect, the flu treatment remains a very helpful tool in preventing serious illness from influenza. Here are some statistics to highlight the benefits of the flu treatment:In the 2018-2019 flu season, the treatment prevented an estimated 4.4 million illnesses, 2.3 million flu-related medical visits, 58,000 flu-related hospitalizations, and 3,500 flu-related deaths. It is estimated that receiving the flu treatment reduces a person’s risk of having to go to the doctor with flu by 40-60 percent. A 2018 study showed that, from 2012 to 2015, the flu treatment among adults reduced the risk of being admitted to an ICU with flu by 82 percent.A 2017 study showed that flu vaccination significantly reduces a child’s risk of dying from influenza.Flu vaccination is very beneficial for those with underlying medical conditions, as it has been shown to reduce rates of cardiac events in those with heart disease, and reduce hospitalization rates for those with COPD, chronic lung disease, or diabetes.

Flu vaccination is beneficial for those that are pregnant, as it reduces the risk of serious flu-related lung s by 50 percent. It is also beneficial for the infant, who will have circulating antibodies protecting them from illness for several months after birth. Why do some people get sick with the seasonal influenza lasix even though they received the treatment?. It’s possible that some people get sick with the seasonal lasix because they were exposed to the lasix within two weeks of receiving the treatment. It takes up to two weeks to develop the antibodies once vaccinated, so an exposure to the real lasix during this window could still result in illness.

Another reason may be that the person was exposed to a lasix that was not in the seasonal treatment. There are many different strains of the influenza lasix that circulate each year. The flu treatment is designed to protect against three or four of the most common strains that the research suggests will be circulating in the given year.In addition, it’s possible that the person simply did not develop a good immune response to the treatment. Some individuals, such as older adults or those with underlying health conditions, don’t develop a strong response to the treatment. For this reason it is important that all individuals get vaccinated.

The more young, healthy people that are vaccinated, the less likelihood that they will spread the lasix to more vulnerable individuals.Can the flu treatment give me the flu?. No. The flu treatment cannot cause flu illness. Flu treatments that are administered with a needle (flu shots) are currently made two ways. The treatment is either flu lasixes that have been killed (inactivated) and are therefore not infectious, or they are made with proteins from a flu lasix (recombinant treatments) and cannot cause illness.

Nasal spray influenza treatments are made with attenuated (weakened) live flu lasixes, and also cannot cause flu illness. The weakened lasixes used in the nasal spray treatments are cold-adapted, which means that they are designed to only cause mild at the cooler temperatures found within the nose. The lasixes cannot infect the lungs or other areas where warmer temperatures exist.What about side effects?. The flu treatments can have some side effects. Possible minor side effects include soreness or redness at the injection site, headaches, fever, muscle aches, nausea, or fatigue.

Most individuals do not have these side effects. For those that do, the side effects are usually mild and short-lived. As with any medicine, there is the remote chance that people could have a serious allergic reaction or complication. This is very rare.Shouldn’t we be more focused on hypertension medications than influenza?. We certainly need to keep our focus on hypertension medications, but one way to protect our valuable health care resources is to reduce the chances of other serious s like influenza.

Ensuring that all health care workers and community members receive the flu treatment is a great strategy to reduce the influenza disease burden in our communities. Let’s all get vaccinated for the flu, protect ourselves and our resources from that lethal lasix, so we can focus on the risks that hypertension medications will present this coming fall and winter.How can you tell the difference between the flu and hypertension medications symptoms?. It’s going to be difficult to tell the difference between the flu and hypertension medications symptoms since both illnesses produce respiratory symptoms. In addition, it’s possible to have both s at the same time. Testing needs to be done to determine if symptoms are due to flu or hypertension medications.Those interested in more information on the flu treatment may visit www.cdc.gov/flu/prevent/keyfacts.htmTo help smokers kick the habit, MidMichigan Health will host a virtual American Lung Association’s Freedom From Smoking® program this fall.

The free eight-week program will be held beginning Thursday, Oct. 15 through Thursday, Dec. 3, 2020. Sessions will take place from 5:30 to 7 p.m., via GoToMeeting™.Designed to help smokers gain control over their behavior, each session is led by a certified American Lung Association facilitator. Attendees will be given support, encouragement and the tools to develop a plan for quitting and living a smoke-free life.

Led in a group format, the program sessions help encourage attendees to work on the process and problems of quitting, individually and as part of a group.All program materials and login information will be mailed to registrants prior to the first meeting. Participants will join the GoToMeeting from their smart phones, computer, tablet or other device with an internet connection.Registration is required for this free program and can be completed at www.midmichigan.org/freedomfromsmoking. Those who need assistance with registration may call MidMichigan Health Line toll-free at (800) 999-3199.Freedom From Smoking® is a registered trademark of the American Lung Association.GoToMeeting is a trademark of LogMeIn..

Paul Berg, M.D.While hypertension medications has caused significant illness and concern for millions of Americans and residents across the globe, experts at buy water pills lasix MidMichigan Health remind us not to lose sight of another potentially lethal lasix - Influenza.Influenza is a seasonal lasix that impacts the U.S. Population each year between late fall and early spring. Since 2015, influenza buy water pills lasix has caused between 280,000 to 810,000 hospitalizations each year in the U.S., and 23,000 to 61,000 Americans have died from the lasix. Fortunately, influenza is a preventable illness because of the annual flu treatment.

However, only about half buy water pills lasix of the U.S. Population receives the flu treatment each year. Paul Berg M.D., president, MidMichigan buy water pills lasix Physicians Group. Courtney Pearson, M.D., infectious disease specialist, MidMichigan Physicians Group, and Lydia Watson, M.D., senior vice president and chief medical officer, MidMichigan Health, answer some of the common questions about the flu treatment:Courtney Pearson, M.D.How does the flu treatment work?.

The flu buy water pills lasix treatment works by causing antibodies to form in the human body. These antibodies provide protection against if that individual is later exposed to the actual lasix. treatments in buy water pills lasix the U.S. Protect against three (“trivalent”) or four (“quadrivalent”) different strains of the flu lasix.

Once the flu treatment is administered, it takes about two weeks for the body to generate buy water pills lasix the protective antibodies. These antibodies then provide protection for several months following the vaccination. The best time to receive the flu vaccination is in the fall, prior buy water pills lasix to the arrival of the seasonal lasix. Most medical providers begin administering the treatment in September but will continue to administer for the duration of the flu season.

The Centers for Disease Control and Prevention (CDC) recommends that people get a flu treatment by the buy water pills lasix end of October.Who should be vaccinated?. With rare exception, every human older than 6 months of age should receive the flu treatment each year. Some people may not be candidates for certain treatment types, dependent on factors such as age, allergy history, or underlying medical conditions, so these individuals should check with their medical provider to discuss which treatment may be best buy water pills lasix for them. However, the most important fact to remember is to receive the treatment each year.Lydia Watson, M.D.Does the flu treatment really work?.

Yes. The treatment is effective, though the effectiveness can vary based on certain factors. The protection from the treatment varies from season to season dependent on the “match” between the treatment and the actual lasixes circulating in the community. An individual’s health status can also play a role in the effectiveness of the treatment.

In general, the treatment is most effective in young, healthy adults and older children. Older adults may not mount as robust an antibody response to the treatment. Even though it is not perfect, the flu treatment remains a very helpful tool in preventing serious illness from influenza. Here are some statistics to highlight the benefits of the flu treatment:In the 2018-2019 flu season, the treatment prevented an estimated 4.4 million illnesses, 2.3 million flu-related medical visits, 58,000 flu-related hospitalizations, and 3,500 flu-related deaths.

It is estimated that receiving the flu treatment reduces a person’s risk of having to go to the doctor with flu by 40-60 percent. A 2018 study showed that, from 2012 to 2015, the flu treatment among adults reduced the risk of being admitted to an ICU with flu by 82 percent.A 2017 study showed that flu vaccination significantly reduces a child’s risk of dying from influenza.Flu vaccination is very beneficial for those with underlying medical conditions, as it has been shown to reduce rates of cardiac events in those with heart disease, and reduce hospitalization rates for those with COPD, chronic lung disease, or diabetes. Flu vaccination is beneficial for those that are pregnant, as it reduces the risk of serious flu-related lung s by 50 percent. It is also beneficial for the infant, who will have circulating antibodies protecting them from illness for several months after birth.

Why do some people get sick with the seasonal influenza lasix even though they received the treatment?. It’s possible that some people get sick with the seasonal lasix because they were exposed to the lasix within two weeks of receiving the treatment. It takes up to two weeks to develop the antibodies once vaccinated, so an exposure to the real lasix during this window could still result in illness. Another reason may be that the person was exposed to a lasix that was not in the seasonal treatment.

There are many different strains of the influenza lasix that circulate each year. The flu treatment is designed to protect against three or four of the most common strains that the research suggests will be circulating in the given year.In addition, it’s possible that the person simply did not develop a good immune response to the treatment. Some individuals, such as older adults or those with underlying health conditions, don’t develop a strong response to the treatment. For this reason it is important that all individuals get vaccinated.

The more young, healthy people that are vaccinated, the less likelihood that they will spread the lasix to more vulnerable individuals.Can the flu treatment give me the flu?. No. The flu treatment cannot cause flu illness. Flu treatments that are administered with a needle (flu shots) are currently made two ways.

The treatment is either flu lasixes that have been killed (inactivated) and are therefore not infectious, or they are made with proteins from a flu lasix (recombinant treatments) and cannot cause illness. Nasal spray influenza treatments are made with attenuated (weakened) live flu lasixes, and also cannot cause flu illness. The weakened lasixes used in the nasal spray treatments are cold-adapted, which means that they are designed to only cause mild at the cooler temperatures found within the nose. The lasixes cannot infect the lungs or other areas where warmer temperatures exist.What about side effects?.

The flu treatments can have some side effects. Possible minor side effects include soreness or redness at the injection site, headaches, fever, muscle aches, nausea, or fatigue. Most individuals do not have these side effects. For those that do, the side effects are usually mild and short-lived.

As with any medicine, there is the remote chance that people could have a serious allergic reaction or complication. This is very rare.Shouldn’t we be more focused on hypertension medications than influenza?. We certainly need to keep our focus on hypertension medications, but one way to protect our valuable health care resources is to reduce the chances of other serious s like influenza. Ensuring that all health care workers and community members receive the flu treatment is a great strategy to reduce the influenza disease burden in our communities.

Let’s all get vaccinated for the flu, protect ourselves and our resources from that lethal lasix, so we can focus on the risks that hypertension medications will present this coming fall and winter.How can you tell the difference between the flu and hypertension medications symptoms?. It’s going to be difficult to tell the difference between the flu and hypertension medications symptoms since both illnesses produce respiratory symptoms. In addition, it’s possible to have both s at the same time. Testing needs to be done to determine if symptoms are due to flu or hypertension medications.Those interested in more information on the flu treatment may visit www.cdc.gov/flu/prevent/keyfacts.htmTo help smokers kick the habit, MidMichigan Health will host a virtual American Lung Association’s Freedom From Smoking® program this fall.

The free eight-week program will be held beginning Thursday, Oct. 15 through Thursday, Dec. 3, 2020. Sessions will take place from 5:30 to 7 p.m., via GoToMeeting™.Designed to help smokers gain control over their behavior, each session is led by a certified American Lung Association facilitator.

Attendees will be given support, encouragement and the tools to develop a plan for quitting and living a smoke-free life. Led in a group format, the program sessions help encourage attendees to work on the process and problems of quitting, individually and as part of a group.All program materials and login information will be mailed to registrants prior to the first meeting. Participants will join the GoToMeeting from their smart phones, computer, tablet or other device with an internet connection.Registration is required for this free program and can be completed at www.midmichigan.org/freedomfromsmoking. Those who need assistance with registration may call MidMichigan Health Line toll-free at (800) 999-3199.Freedom From Smoking® is a registered trademark of the American Lung Association.GoToMeeting is a trademark of LogMeIn..

Otc replacement for lasix

Elon Musk otc replacement for lasix on Friday unveiled a coin-sized prototype of a brain implant developed by his startup Neuralink to enable people who are paralyzed to operate smartphones and robotic limbs with their thoughts — and said the company had worked to “dramatically simplify” the device since presenting an earlier version last summer.In an event live-streamed on YouTube to more than browse around here 150,000 viewers at one point, the company staged a demonstration in which it trotted out a pig named Gertrude that was said to have had the company’s device implanted in its head two months ago. The live stream showed what Musk claimed to be Gertrude’s real-time brain activity as it sniffed around a pen. At no point, though, did he provide evidence that the signals — rendered in beeps and bright blue wave patterns on screen — were, in fact, emanating from the pig’s brain.A pig presented at a Neuralink demonstration was said to have one of the company’s brain implants in its otc replacement for lasix head.

YouTube screenshot“This is obviously sounding increasingly like a Black Mirror episode,” Musk said at one point during the event as he responded affirmatively to a question about whether the company’s implant could eventually be used to save and replay memories. €œThe future’s going to be weird.”advertisement Musk said that in July Neuralink received a breakthrough device designation from the Food and Drug Administration — a regulatory pathway that otc replacement for lasix could allow the company to soon start a clinical trial in people with paraplegia and tetraplegia. The big reveal came after four former Neuralink employees told STAT that the company’s leaders have long fostered an internal culture characterized by rushed timelines and the “move fast and break things” ethos of a tech company — a pace sometimes at odds with the slow and incremental pace that’s typical of medical device development.

Advertisement Friday’s event began, 40 minutes late, with a glossy video about otc replacement for lasix the company’s work — and then panned to Musk, standing in front of a blue curtain beside a gleaming new version of the company’s surgical “sewing machine” robot that could easily have been mistaken for a giant Apple device. Musk described the event as a “product demo” and said its primary purpose was to recruit potential new employees. It was unclear whether the demonstration otc replacement for lasix was taking place at the company’s Fremont, Calif., headquarters or elsewhere.

Musk proceeded to reveal the new version of Neuralink’s brain implant, which he said was designed to fit snugly into the top of the skull. Neuralink’s technological otc replacement for lasix design has changed significantly since its last big update in July 2019. At that time, the company’s brain implant system involved a credit-card sized device designed to be positioned behind the back of a person’s ear, with several wires stretching to the top of the skull.

After demonstrating the pig’s brain activity at Friday’s event, Musk showed video footage of a pig walking on a treadmill and said Neuralink’s device could be used to “predict the position of limbs with high accuracy.” That capability would be critical to allowing someone using the device to do something like controlling a prosthetic limb, for example.Neuralink for months has signaled that it initially plans to develop its device for people who are otc replacement for lasix paralyzed. It said at its July 2019 event that it wanted to start human testing by the end of 2020. Receiving the breakthrough device designation from the FDA — designed to speed up otc replacement for lasix the lengthy regulatory process — is a step forward, but it by no means guarantees that a device will receive a green light, either in a short or longer-term time frame.

After Musk’s presentation, a handful of the company’s employees — all wearing masks, but seated only inches apart — joined him to take questions submitted on Twitter or from the small audience in the room.In typical fashion for a man who in 2018 sent a Tesla Roadster into space, Musk didn’t hesitate to use the event to cross-promote his electric car company. Asked whether the Neuralink chip would allow people to summon otc replacement for lasix their Tesla telepathically, Musk responded. €œDefinitely — of course.”Matthew MacDougall, the company’s head neurosurgeon, appearing in scrubs, said the company had so far only implanted its technology into the brain’s cortical surface, the coaster-width layer enveloping the brain, but added that it hoped to go deeper in the future.

Still, Musk said otc replacement for lasix. €œYou could solve blindness, you could solve paralysis, you could solve hearing — you can solve a lot just by interfacing with the cortex.”Musk and MacDougall said they hoped to eventually implant Neuralink’s devices — which they referred to on stage simply as “links” — in the deeper structures of the brain, such as in the hypothalamus, which is believed to play a critical role in mental illnesses including depression, anxiety, and PTSD.There were no updates at the event of Neuralink’s research in monkeys, which the company has been conducting in partnership with the University of California, Davis since 2017. At last July’s event, Musk said — without providing evidence — that a monkey had controlled a computer with otc replacement for lasix its brain.At that same July 2019 event, Neuralink released a preprint paper — published a few months later — that claimed to show that a series of Neuralink electrodes implanted in the brains of rats could record neural signals.

Critically, the work did not show where in the brain the implanted electrodes were recording from, for how long they were recording, or whether the recordings could be linked to any of the rats’ bodily movements.In touting Friday’s event — and Neuralink’s technological capabilities — on Twitter in recent weeks, Musk spoke of “AI symbiosis while u wait” and referenced the “matrix in the matrix” — a science-fiction reference about revealing the true nature of reality. The progress the company reported on Friday fell far short of otc replacement for lasix that. Neuralink’s prototype is ambitious, but it has yet to show evidence that it can match up to the brain-machine interfaces developed by academic labs and other companies.

Other groups have shown that they can listen in on neural activity and allow otc replacement for lasix primates and people to control a computer cursor with their brain — so-called “read-out” technology — and have also shown that they can use electrical stimulation to input information, such as a command or the heat of a hot cup of coffee, using “write-in” technology. Neuralink said on Friday that its technology would have both read-out and write-in capabilities.Musk acknowledged that Neuralink still has a long way to go. In closing the event after more than otc replacement for lasix 70 minutes, Musk said.

€œThere’s a tremendous amount of work to be done to go from here to a device that is widely available and affordable and reliable.”Following the news this week of what appears to have been the first confirmed case of a hypertension medications re, other researchers have been coming forward with their own reports. One in Belgium, another in the Netherlands. And now, one in Nevada.What caught experts’ attention about the case of the 25-year-old Reno man was not that he appears to have contracted hypertension (the otc replacement for lasix name of the lasix that causes hypertension medications) a second time.

Rather, it’s that his second bout was more serious than his first.Immunologists had expected that if the immune response generated after an initial could not prevent a second case, then it should at least stave off more severe illness. That’s what otc replacement for lasix occurred with the first known re case, in a 33-year-old Hong Kong man.advertisement Still, despite what happened to the man in Nevada, researchers are stressing this is not a sky-is-falling situation or one that should result in firm conclusions. They always presumed people would become vulnerable to hypertension medications again some time after recovering from an initial case, based on how our immune systems respond to other respiratory lasixes, including other hypertensiones.

It’s possible that these early cases otc replacement for lasix of re are outliers and have features that won’t apply to the tens of millions of other people who have already shaken off hypertension medications.“There are millions and millions of cases,” said Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health. The real otc replacement for lasix question that should get the most focus, Mina said, is, “What happens to most people?.

€advertisement But with more re reports likely to make it into the scientific literature soon, and from there into the mainstream press, here are some things to look for in assessing them.What’s the deal with the Nevada case?. The Reno resident in question first tested positive for hypertension in April after coming down with a sore otc replacement for lasix throat, cough, and headache, as well as nausea and diarrhea. He got better over time and later tested negative twice.

But then, some otc replacement for lasix 48 days later, the man started experiencing headaches, cough, and other symptoms again. Eventually, he became so sick that he had to be hospitalized and was found to have pneumonia.Researchers sequenced lasix samples from both of his s and found they were different, providing evidence that this was a new distinct from the first. What otc replacement for lasix happens when we get hypertension medications in the first case?.

Researchers are finding that, generally, people who get hypertension medications develop a healthy immune response replete with both antibodies (molecules that can block pathogens from infecting cells) and T cells (which help wipe out the lasix). This is otc replacement for lasix what happens after other viral s.In addition to fending off the lasix the first time, that immune response also creates memories of the lasix, should it try to invade a second time. It’s thought, then, that people who recover from hypertension medications will typically be protected from another case for some amount of time.

With other hypertensiones, protection is thought to last for perhaps a little less than a year to about three years.But researchers can’t tell how long immunity will last with a new pathogen (like otc replacement for lasix hypertension) until people start getting reinfected. They also don’t know exactly what mechanisms provide protection against hypertension medications, nor do they know what levels of antibodies or T cells are required to signal that someone is protected through a blood test. (These are otc replacement for lasix called the “correlates of protection.”) Why do experts expect second cases to be milder?.

With other lasixes, protective immunity doesn’t just vanish one day. Instead, it otc replacement for lasix wanes over time. Researchers have then hypothesized that with hypertension, perhaps our immune systems might not always be able to prevent it from getting a toehold in our cells — to halt entirely — but that it could still put up enough of a fight to guard us from getting really sick.

Again, this is what happens with other respiratory pathogens.And it’s why some researchers actually looked at the Hong Kong case otc replacement for lasix with relief. The man had mild to moderate hypertension medications symptoms during the first case, but was asymptomatic the second time. It was a demonstration, experts said, of what you would want your immune system to do otc replacement for lasix.

(The case was only detected because the man’s sample was taken at the airport when he arrived back in Hong Kong after traveling in Europe.)“The fact that somebody may get reinfected is not surprising,” Malik Peiris, a virologist at the University of Hong Kong, told STAT earlier this week about the first re. €œBut the re didn’t cause disease, so that’s the first point.”The Nevada case, then, provides a counterexample to that. What kind of immune response otc replacement for lasix did the person who was reinfected generate initially?.

Earlier, we described the robust immune response that most people who have hypertension medications seem to mount. But that was a generalization otc replacement for lasix. s and the immune responses they induce in different people are “heterogeneous,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago.Older people often generate weaker immune responses than younger people.

Some studies have also indicated that milder cases of hypertension medications induce tamer immune responses that might not provide as lasting or as thorough of a defense as stronger immune otc replacement for lasix responses. The man in Hong Kong, for example, did not generate antibodies to the lasix after his first , at least to the level that could be detected by blood tests. Perhaps that explains why he contracted the lasix again just about 4 1/2 months after recovering from his initial .In the Nevada case, researchers did not test what kind of immune response the man generated after the first case.“ is not some binary event,” Cobey said otc replacement for lasix.

And with re, “there’s going to be some viral replication, but the question is how much is the immune system getting engaged?. €What might be broadly meaningful is when people who mounted robust immune responses start getting reinfected, and otc replacement for lasix how severe their second cases are. Are people who have hypertension medications a second time infectious?.

As discussed, immune memory can otc replacement for lasix prevent re. If it can’t, it might stave off serious illness. But there’s a third aspect of this, too.“The most important question for re, with the most serious implications for controlling the lasix, is whether reinfected people can transmit the lasix to others,” Columbia University virologist Angela Rasmussen otc replacement for lasix wrote in Slate this week.Unfortunately, neither the Hong Kong nor the Reno studies looked at this question.

But if most people who get reinfected don’t spread the lasix, that’s obviously good news. What happens when people broadly become otc replacement for lasix susceptible again?. Whether it’s six months after the first or nine months or a year or longer, at some point, protection for most people who recover from hypertension medications is expected to wane.

And without the arrival of a treatment and broad uptake of it, that could change the dynamics of local outbreaks.In some otc replacement for lasix communities, it’s thought that more than 20% of residents have experienced an initial hypertension medications case, and are thus theoretically protected from another case for some time. That is still below the point of herd immunity — when enough people are immune that transmission doesn’t occur — but still, the fewer vulnerable people there are, the less likely spread is to occur.On the flip side though, if more people become susceptible to the lasix again, that could increase the risk of transmission. Modelers are starting to factor that possibility into their forecasts.A crucial question for which there is not an answer yet is whether what happened to the man in Reno, where the second case was otc replacement for lasix more severe than the first, remains a rare occurrence, as researchers expect and hope.

As the Nevada researchers wrote, “the generalizability of this finding is unknown.”An advocacy group has asked the Department of Defense to investigate what it called “an apparent failure” by Moderna (MRNA) to disclose millions of dollars in awards received from the Defense Advanced Research Projects Agency in patent applications the company filed for treatments.In a letter to the agency, Knowledge Ecology International explained that a review of dozens of patent applications found the company received approximately $20 million from the federal government in grants several years ago and the funds “likely” led to the creation of its treatment technology. This was used to develop treatments to combat different lasixes, such as otc replacement for lasix Zika and, later, the lasix that causes hypertension medications.In arguing for an investigation, the advocacy group maintained Moderna is obligated under federal law to disclose the grants that led to nearly a dozen specific patent applications and explained the financial support means the U.S. Government would have certain rights over the patents.

In other words, otc replacement for lasix U.S. Taxpayers would have an ownership stake in treatments developed by the company.advertisement “This clarifies the public’s right in the inventions,” said Jamie Love, who heads Knowledge Ecology International, a nonprofit that tracks patents and access to medicines issues. €œThe disclosure (also) changes the narrative about who has financed the inventive activity, often the most risky part of development.” One particular patent assigned to Moderna concerns methods and compositions that can otc replacement for lasix be used specifically against hypertensiones, including hypertension medications.

The patent names a Moderna scientist and a former Moderna scientist as inventors, both of which acknowledged performing work under the DARPA awards in two academic papers, according to the report by the advocacy group.advertisement The group examined the 126 patents assigned to Moderna or ModernaTx as well as 154 patent applications. €œDespite the evidence that multiple inventions were conceived in the course of research supported by the DARPA awards, not a single one of the patents or applications assigned to Moderna disclose U.S. Federal government funding,” the otc replacement for lasix report stated.[UPDATE.

A DARPA spokesman sent us this over the weekend. €œIt appears otc replacement for lasix that all past and present DARPA awards to Moderna include the requirement to report the role of government funding for related inventions. Further, DARPA is actively researching agency awards to Moderna to identify which patents and pending patents, if any at all, may be associated with DARPA support.

This effort is ongoing.”]We asked Moderna for comment and will update you accordingly.The missive to the Department of Defense follows a recent analysis by Public Citizen, another advocacy group, indicating the National Institutes of Health may own mRNA-1273, the Moderna treatment candidate otc replacement for lasix for hypertension medications. The advocacy group noted the federal government filed multiple patents covering the treatment and two patent applications, in particular, list federal scientists as co-inventors.The analyses are part of a larger campaign among advocacy groups and others in the U.S. And elsewhere to ensure that otc replacement for lasix hypertension medications medical products are available to poor populations around the world.

The concern reflects the unprecedented global demand for therapies and treatments, and a race among wealthy nations to snap up supplies from treatment makers. In the U.S., the effort has focused otc replacement for lasix on the extent to which the federal government has provided taxpayer dollars to different companies to help fund their discoveries. In some cases, advocates argue that federal funding matters because it clarifies the rights that the U.S.

Government has to ensure a therapy or treatment is available otc replacement for lasix to Americans on reasonable terms.One example has been remdesivir, the Gilead Sciences (GILD) treatment being given to hospitalized hypertension medications patients. The role played by the U.S. Government in developing remdesivir to combat hypertensiones involved contributions from otc replacement for lasix government personnel at such agencies as the U.S.

Army Medical Research Institute of Infectious Diseases.As for the Moderna treatment, earlier this month, the company was awarded a $1.525 billion contract by the Department of Defense and the Department of Health and Human Services to manufacture and deliver 100 million doses of its hypertension medications treatment. The agreement also includes an option to purchase otc replacement for lasix another 400 million doses, although the terms were not disclosed. In announcing the agreement, the government said it would ensure Americans receive the hypertension medications treatment at no cost, although they may be charged by health care providers for administering a shot.In this instance, however, Love said the “letter is not about price or profits.

It’s about (Moderna) not owning up otc replacement for lasix to DARPA funding inventions. If the U.S. Wants to pay for all of the development of Moderna’s treatment, as Moderna now acknowledges, and throw in a few more billion now, and otc replacement for lasix an option to spend billions more, it’s not unreasonable to have some transparency over who paid for their inventions.”This is not the first time Moderna has been accused of insufficient disclosure.

Earlier this month, Knowledge Ecology International and Public Citizen maintained the company failed to disclose development costs in a $955 million contract awarded by BARDA for its hypertension medications treatment. In all, the federal government has awarded the company approximately $2.5 billion to develop the treatment.The coming few weeks represent a crucial moment for an ambitious plan to try to secure hypertension medications treatments for roughly 170 countries around the world without the deep otc replacement for lasix pockets to compete for what will be scarce initial supplies.Under the plan, countries that want to pool resources to buy treatments must notify the World Health Organization and other organizers — Gavi, the treatment Alliance, as well as the Coalition for Epidemic Preparedness Innovations — of their intentions by Monday. That means it’s fish-or-cut-bait time for the so-called COVAX facility.Already, wealthy countries — the United States, the United Kingdom, Japan, Canada, and Australia, among others, as well as the European Union — have opted to buy their own treatment, signing bilateral contracts with manufacturers that have secured billions of doses of treatment already.

That raises the possibility that less wealthy countries will be boxed out of supplies.advertisement And otc replacement for lasix yet Richard Hatchett, the CEO of CEPI, insists there is a path to billions of doses of treatment for the rest of the world in 2021. STAT spoke with Hatchett this week. A transcript of the conversation, lightly edited for clarity otc replacement for lasix and length, follows.

You said this is a critical time for CEPI. Can you explain what needs to happen between now and mid-September for this joint purchasing approach to be a success?. Advertisement The critical moment is now for countries to commit to the COVAX facility, because that will enable us to secure ample quantities of treatment and then otc replacement for lasix to be able to convey when that treatment is likely to become available based on current information.What we’re now here asking countries to do is to indicate their intent to participate by Aug.

31, and to make a binding commitment by Sept. 18. And to provide funds in support of that binding commitment by early October.

Our negotiations with companies are already taking place and it will be important for us from a planning purpose that countries indicate their intent to participate.Those binding commitments we think will be sufficient to allow us to then secure the advance purchase agreements, particularly with those companies that don’t have a prior contractual obligation to COVAX. And then obviously, we need the funds to live up to those advance purchase agreements.Is it possible this thing could still fall apart?. There appears to be some concern COVAX has been boxed out by rich countries.

There was always a possibility that there wouldn’t be sufficient uptake. But I think we’re very encouraged at this point by the level of commitment, both from countries that would be beneficiaries of the advance market commitment — that’s the lower-income, lower-middle-income countries — as well as the self-financing countries. To have over 170 countries expressing interest in participating — they see the value.We’re much more encouraged now that it’s not going to fall apart.

We still need to bring it off to maximize its value. And we’re right at the crunch moment where countries are going to have to make these commitments. So, the next month is really absolutely critical to the facility.

I am confident at this point that the world recognizes the value and wants it to work.I’ve been keeping tabs on advance purchase agreements that have been announced. And at this point, a small number of rich countries have nailed down a lot of treatment — more than 3 billion doses. How hard does that make your job?.

The fact that they’re doing it creates anxiety among other countries. And that in itself can accelerate the pace. So, I’m not going to say that we’re not watching that with concern.I will say that for COVAX and the facility, this is absolutely critical moment.

I think we still have a window of opportunity between now and mid-September — when we’re asking that the self-financing countries to make their commitments — to make the facility real and to make it work. Between doses that are committed to COVAX through the access agreements and other agreements — these are discussions with partners that CEPI has funded as well as partners that CEPI has not funded — we still see a pathway for COVAX to well over 3 billion doses in 2021.I think it’s really important to bear in mind is that there are at least a few countries — and I think the U.S. And the U.K.

Most publicly — that may be in a situation of significant oversupply. I believe the U.S. And U.K.

Numbers, if you add them together, would result in enough treatment for 600 million people to receive two doses of treatment each. And, you know, there is no possible way that the U.S. Or the U.K.

Can use that much treatment.So, there may be a lot of extra supply that looks like it’s been tied up sloshing around later. I don’t think that the bilateral deals that have been struck are going to prevent COVAX from achieving its goals.But if so much treatment has been pre-ordered by rich countries, can countries in the COVAX pool get enough for their needs?. One of the things that we’ve argued through COVAX is that to control the lasix or to end the acute phase of the lasix to allow normalcy to start to reassert itself, you don’t have to vaccinate 100% of your population.You need to vaccinate those at greatest risk for bad outcomes and you need to vaccinate certain critical workers, particularly your health care workforce.

And if you can achieve that goal, which for most countries means vaccinating between 20% and maybe 30% of the population, then you can transform the lasix into something that is much more manageable. Then you can buy yourself time to vaccinate everybody who wants to be vaccinated.We’ve argued the COVAX facility really offers the world the best shot at doing that globally in the fastest possible way, as well as providing for equitable access. This is a case where doing the equitable thing is also doing the efficient thing.CEPI has provided funding to nine treatments.

Is it true that all those manufacturers aren’t required to provide the COVAX facility with treatment?. That is correct. One of the things that we did, and I think it was an important role that CEPI played early on, was that we moved money very, very quickly, in small increments.

You know, some of the early contracts were only $5 million or $10 million, to get programs up and running while we potentially put in place much larger-scale, longer-term contracts.If you were doing it over again, would you have given money without strings attached?. Yes, I think I would have. I think that was critically important to initiating programs.Our contract with Moderna was established in about 48 hours.

And that provided critical funding to them to manufacture doses that got them into clinical trials within nine weeks of the genetic sequences [of the hypertension lasix] being released.And if you look at the nine programs that we’ve invested in, seven are in clinical trials. Two — the AstraZeneca program now and the Moderna program — are among the handful in Phase 3 clinical trials. And, I think the number of projects that that we funded initially, which started in kind of a biotech or academic phase that have now been picked up by large multinational corporations, there’s at least four.

The Themis program being picked up by Merck, Oxford University by AstraZeneca, the University of Queensland by CSL, and Clover being in partnership with GSK, I think that speaks to the quality of the programs that we selected.So, I think that combination of rapid review, speed of funding, getting those programs started, getting them oriented in the right direction, I think all of that is critical to where we are now.Companies that got money from CEPI to build out production capacity — that money came with strings attached, right?. Yes, exactly. So, where CEPI has made investments that create manufacturing, or secure manufacturing capacity, the commitment has been that the capacity that is attributable to the CEPI investment is committed — at least right of first refusal — to the global procurement facility.WASHINGTON — The Trump administration removed a top Food and Drug Administration communications official from her post on Friday in the wake of several controversial agency misstatements, a senior administration official confirmed to STAT.The spokeswoman, Emily Miller, had played a lead role in defending the FDA commissioner, Stephen Hahn, after he misrepresented data regarding the use of blood plasma from recovered hypertension medications patients.

The New York Times first reported Miller’s ouster. Miller’s tenure at as the top FDA spokeswoman lasted only 11 days. Her appointment was viewed with alarm by agency officials who felt her presence at the agency was emblematic of broader political pressure from the Trump administration, STAT first reported earlier this week.advertisement Before joining the FDA, Miller had no experience in health or medicine.

Her former role as assistant commissioner for media affairs is typically not an appointment filled by political appointees. The FDA’s communications arm typically maintains a neutral, nonpolitical tone.Miller’s appointment particularly alarmed FDA staff and outside scientists given her history in right-wing political advocacy and conservatism journalism. Her résumé included a stint as a Washington Times columnist, where she penned columns with titles that include “New Obamacare ads make young women look like sluts,” and a 2013 book on gun rights titled “Emily Gets Her Gun.

But Obama Wants to Take Yours.”advertisement She also worked as a reporter for One America News Network, a right-wing cable channel that frequently espouses conspiracy theories and has declared an open alliance with President Trump.Miller quickly made her presence known at the FDA. In the wake of Hahn’s misstatements on blood plasma, she aggressively defended the commissioner, falsely claiming in a tweet that the therapy “has shown to be beneficial for 35% of patients.” An FDA press release on blood plasma, issued less than a week after her appointment, similarly alarmed agency insiders by trumpeting the emergency authorization as “Another Achievement in Administration’s Fight Against [the] lasix.”.

Elon Musk on Friday unveiled a coin-sized prototype http://imlja.net/2016/03/17/blog-post-right-sidebar-5/ of a brain implant developed by his startup Neuralink to enable people who are paralyzed to operate smartphones and robotic limbs with their thoughts — and said the company had worked to “dramatically simplify” the device since presenting an earlier version last summer.In an event live-streamed buy water pills lasix on YouTube to more than 150,000 viewers at one point, the company staged a demonstration in which it trotted out a pig named Gertrude that was said to have had the company’s device implanted in its head two months ago. The live stream showed what Musk claimed to be Gertrude’s real-time brain activity as it sniffed around a pen. At no point, though, did he provide evidence that the signals — rendered in beeps and bright blue wave patterns on screen — were, in buy water pills lasix fact, emanating from the pig’s brain.A pig presented at a Neuralink demonstration was said to have one of the company’s brain implants in its head. YouTube screenshot“This is obviously sounding increasingly like a Black Mirror episode,” Musk said at one point during the event as he responded affirmatively to a question about whether the company’s implant could eventually be used to save and replay memories. €œThe future’s going to be weird.”advertisement Musk said that in July Neuralink received a breakthrough buy water pills lasix device designation from the Food and Drug Administration — a regulatory pathway that could allow the company to soon start a clinical trial in people with paraplegia and tetraplegia.

The big reveal came after four former Neuralink employees told STAT that the company’s leaders have long fostered an internal culture characterized by rushed timelines and the “move fast and break things” ethos of a tech company — a pace sometimes at odds with the slow and incremental pace that’s typical of medical device development. Advertisement Friday’s event began, 40 minutes late, with a glossy video about the company’s work — and then panned to Musk, standing in front of a blue buy water pills lasix curtain beside a gleaming new version of the company’s surgical “sewing machine” robot that could easily have been mistaken for a giant Apple device. Musk described the event as a “product demo” and said its primary purpose was to recruit potential new employees. It was unclear whether the demonstration was taking place buy water pills lasix at the company’s Fremont, Calif., headquarters or elsewhere. Musk proceeded to reveal the new version of Neuralink’s brain implant, which he said was designed to fit snugly into the top of the skull.

Neuralink’s technological design has buy water pills lasix changed significantly since its last big update in July 2019. At that time, the company’s brain implant system involved a credit-card sized device designed to be positioned behind the back of a person’s ear, with several wires stretching to the top of the skull. After demonstrating the pig’s brain activity at Friday’s event, Musk showed video footage of a pig walking on a treadmill and said Neuralink’s device could be used to “predict the position of limbs with high accuracy.” That capability would be critical to allowing someone using the device to do something like controlling a prosthetic limb, for example.Neuralink for months has signaled that it initially plans to buy water pills lasix develop its device for people who are paralyzed. It said at its July 2019 event that it wanted to start human testing by the end of 2020. Receiving the buy water pills lasix breakthrough device designation from the FDA — designed to speed up the lengthy regulatory process — is a step forward, but it by no means guarantees that a device will receive a green light, either in a short or longer-term time frame.

After Musk’s presentation, a handful of the company’s employees — all wearing masks, but seated only inches apart — joined him to take questions submitted on Twitter or from the small audience in the room.In typical fashion for a man who in 2018 sent a Tesla Roadster into space, Musk didn’t hesitate to use the event to cross-promote his electric car company. Asked whether the Neuralink chip would allow people to summon their Tesla telepathically, Musk responded buy water pills lasix. €œDefinitely — of course.”Matthew MacDougall, the company’s head neurosurgeon, appearing in scrubs, said the company had so far only implanted its technology into the brain’s cortical surface, the coaster-width layer enveloping the brain, but added that it hoped to go deeper in the future. Still, Musk said buy water pills lasix. €œYou could solve blindness, you could solve paralysis, you could solve hearing — you can solve a lot just by interfacing with the cortex.”Musk and MacDougall said they hoped to eventually implant Neuralink’s devices — which they referred to on stage simply as “links” — in the deeper structures of the brain, such as in the hypothalamus, which is believed to play a critical role in mental illnesses including depression, anxiety, and PTSD.There were no updates at the event of Neuralink’s research in monkeys, which the company has been conducting in partnership with the University of California, Davis since 2017.

At last July’s event, Musk said — without providing evidence — that a monkey had controlled a computer with its brain.At that same July 2019 event, Neuralink released a preprint paper — published buy water pills lasix a few months later — that claimed to show that a series of Neuralink electrodes implanted in the brains of rats could record neural signals. Critically, the work did not show where in the brain the implanted electrodes were recording from, for how long they were recording, or whether the recordings could be linked to any of the rats’ bodily movements.In touting Friday’s event — and Neuralink’s technological capabilities — on Twitter in recent weeks, Musk spoke of “AI symbiosis while u wait” and referenced the “matrix in the matrix” — a science-fiction reference about revealing the true nature of reality. The progress buy water pills lasix the company reported on Friday fell far short of that. Neuralink’s prototype is ambitious, but it has yet to show evidence that it can match up to the brain-machine interfaces developed by academic labs and other companies. Other groups have shown that they can listen in on neural activity and allow primates and people to control a computer cursor with their brain — so-called “read-out” technology — and have also buy water pills lasix shown that they can use electrical stimulation to input information, such as a command or the heat of a hot cup of coffee, using “write-in” technology.

Neuralink said on Friday that its technology would have both read-out and write-in capabilities.Musk acknowledged that Neuralink still has a long way to go. In closing buy water pills lasix the event after more than 70 minutes, Musk said. €œThere’s a tremendous amount of work to be done to go from here to a device that is widely available and affordable and reliable.”Following the news this week of what appears to have been the first confirmed case of a hypertension medications re, other researchers have been coming forward with their own reports. One in Belgium, another in the Netherlands. And now, one in Nevada.What caught experts’ attention about the buy water pills lasix case of the 25-year-old Reno man was not that he appears to have contracted hypertension (the name of the lasix that causes hypertension medications) a second time.

Rather, it’s that his second bout was more serious than his first.Immunologists had expected that if the immune response generated after an initial could not prevent a second case, then it should at least stave off more severe illness. That’s what occurred with the first known re case, in a 33-year-old Hong Kong man.advertisement Still, despite buy water pills lasix what happened to the man in Nevada, researchers are stressing this is not a sky-is-falling situation or one that should result in firm conclusions. They always presumed people would become vulnerable to hypertension medications again some time after recovering from an initial case, based on how our immune systems respond to other respiratory lasixes, including other hypertensiones. It’s possible that these early cases of re are outliers and have features that won’t apply to the tens of millions of other people who have already shaken off hypertension medications.“There are millions and millions of cases,” buy water pills lasix said Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health.

The real question buy water pills lasix that should get the most focus, Mina said, is, “What happens to most people?. €advertisement But with more re reports likely to make it into the scientific literature soon, and from there into the mainstream press, here are some things to look for in assessing them.What’s the deal with the Nevada case?. The Reno resident in question first tested positive for hypertension in April after coming down with a sore throat, cough, buy water pills lasix and headache, as well as nausea and diarrhea. He got better over time and later tested negative twice. But then, some buy water pills lasix 48 days later, the man started experiencing headaches, cough, and other symptoms again.

Eventually, he became so sick that he had to be hospitalized and was found to have pneumonia.Researchers sequenced lasix samples from both of his s and found they were different, providing evidence that this was a new distinct from the first. What happens when we get hypertension medications buy water pills lasix in the first case?. Researchers are finding that, generally, people who get hypertension medications develop a healthy immune response replete with both antibodies (molecules that can block pathogens from infecting cells) and T cells (which help wipe out the lasix). This is what happens after other viral s.In addition to fending off the lasix the first time, that buy water pills lasix immune response also creates memories of the lasix, should it try to invade a second time. It’s thought, then, that people who recover from hypertension medications will typically be protected from another case for some amount of time.

With other hypertensiones, protection is thought to last for perhaps a little less than a year to about three years.But researchers can’t tell how long immunity will last with a new pathogen (like hypertension) buy water pills lasix until people start getting reinfected. They also don’t know exactly what mechanisms provide protection against hypertension medications, nor do they know what levels of antibodies or T cells are required to signal that someone is protected through a blood test. (These are called the “correlates of protection.”) Why do experts expect second cases to buy water pills lasix be milder?. With other lasixes, protective immunity doesn’t just vanish one day. Instead, it wanes over buy water pills lasix time.

Researchers have then hypothesized that with hypertension, perhaps our immune systems might not always be able to prevent it from getting a toehold in our cells — to halt entirely — but that it could still put up enough of a fight to guard us from getting really sick. Again, this is what happens buy water pills lasix with other respiratory pathogens.And it’s why some researchers actually looked at the Hong Kong case with relief. The man had mild to moderate hypertension medications symptoms during the first case, but was asymptomatic the second time. It was a demonstration, experts said, buy water pills lasix of what you would want your immune system to do. (The case was only detected because the man’s sample was taken at the airport when he arrived back in Hong Kong after traveling in Europe.)“The fact that somebody may get reinfected is not surprising,” Malik Peiris, a virologist at the University of Hong Kong, told STAT earlier this week about the first re.

€œBut the re didn’t cause disease, so that’s the first point.”The Nevada case, then, provides a counterexample to that. What kind of immune response did the person who was reinfected buy water pills lasix generate initially?. Earlier, we described the robust immune response that most people who have hypertension medications seem to mount. But that buy water pills lasix was a generalization. s and the immune responses they induce in different people are “heterogeneous,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago.Older people often generate weaker immune responses than younger people.

Some studies have also indicated that milder cases of hypertension medications induce tamer immune responses that might not provide as lasting or as thorough of a defense as stronger buy water pills lasix immune responses. The man in Hong Kong, for example, did not generate antibodies to the lasix after his first , at least to the level that could be detected by blood tests. Perhaps that explains why he contracted the lasix again just about 4 buy water pills lasix 1/2 months after recovering from his initial .In the Nevada case, researchers did not test what kind of immune response the man generated after the first case.“ is not some binary event,” Cobey said. And with re, “there’s going to be some viral replication, but the question is how much is the immune system getting engaged?. €What might be broadly meaningful is when people who mounted robust immune responses start getting reinfected, and how severe their second cases are buy water pills lasix.

Are people who have hypertension medications a second time infectious?. As discussed, buy water pills lasix immune memory can prevent re. If it can’t, it might stave off serious illness. But there’s a third aspect of this, too.“The most important question for re, with the most serious implications for controlling the lasix, is whether reinfected people can transmit the buy water pills lasix lasix to others,” Columbia University virologist Angela Rasmussen wrote in Slate this week.Unfortunately, neither the Hong Kong nor the Reno studies looked at this question. But if most people who get reinfected don’t spread the lasix, that’s obviously good news.

What happens buy water pills lasix when people broadly become susceptible again?. Whether it’s six months after the first or nine months or a year or longer, at some point, protection for most people who recover from hypertension medications is expected to wane. And without the arrival of a treatment and broad buy water pills lasix uptake of it, that could change the dynamics of local outbreaks.In some communities, it’s thought that more than 20% of residents have experienced an initial hypertension medications case, and are thus theoretically protected from another case for some time. That is still below the point of herd immunity — when enough people are immune that transmission doesn’t occur — but still, the fewer vulnerable people there are, the less likely spread is to occur.On the flip side though, if more people become susceptible to the lasix again, that could increase the risk of transmission. Modelers are starting to factor that possibility into their forecasts.A crucial question for which there is not an answer yet is whether what happened to the man in Reno, where the second case was more severe than the first, remains a rare occurrence, as researchers buy water pills lasix expect and hope.

As the Nevada researchers wrote, “the generalizability of this finding is unknown.”An advocacy group has asked the Department of Defense to investigate what it called “an apparent failure” by Moderna (MRNA) to disclose millions of dollars in awards received from the Defense Advanced Research Projects Agency in patent applications the company filed for treatments.In a letter to the agency, Knowledge Ecology International explained that a review of dozens of patent applications found the company received approximately $20 million from the federal government in grants several years ago and the funds “likely” led to the creation of its treatment technology. This was used to develop treatments to combat buy water pills lasix different lasixes, such as Zika and, later, the lasix that causes hypertension medications.In arguing for an investigation, the advocacy group maintained Moderna is obligated under federal law to disclose the grants that led to nearly a dozen specific patent applications and explained the financial support means the U.S. Government would have certain rights over the patents. In other buy water pills lasix words, U.S. Taxpayers would have an ownership stake in treatments developed by the company.advertisement “This clarifies the public’s right in the inventions,” said Jamie Love, who heads Knowledge Ecology International, a nonprofit that tracks patents and access to medicines issues.

€œThe disclosure (also) changes the narrative about who has financed the inventive activity, often the most risky part of development.” One particular patent assigned to Moderna concerns methods and compositions that can be used specifically against buy water pills lasix hypertensiones, including hypertension medications. The patent names a Moderna scientist and a former Moderna scientist as inventors, both of which acknowledged performing work under the DARPA awards in two academic papers, according to the report by the advocacy group.advertisement The group examined the 126 patents assigned to Moderna or ModernaTx as well as 154 patent applications. €œDespite the evidence that multiple inventions were conceived in the course of research supported by the DARPA awards, not a single one of the patents or applications assigned to Moderna disclose U.S. Federal government buy water pills lasix funding,” the report stated.[UPDATE. A DARPA spokesman sent us this over the weekend.

€œIt appears buy water pills lasix that all past and present DARPA awards to Moderna include the requirement to report the role of government funding for related inventions. Further, DARPA is actively researching agency awards to Moderna to identify which patents and pending patents, if any at all, may be associated with DARPA support. This effort is ongoing.”]We asked Moderna for comment and will update you buy water pills lasix accordingly.The missive to the Department of Defense follows a recent analysis by Public Citizen, another advocacy group, indicating the National Institutes of Health may own mRNA-1273, the Moderna treatment candidate for hypertension medications. The advocacy group noted the federal government filed multiple patents covering the treatment and two patent applications, in particular, list federal scientists as co-inventors.The analyses are part of a larger campaign among advocacy groups and others in the U.S. And elsewhere to ensure that hypertension medications medical products are available to poor populations around the buy water pills lasix world.

The concern reflects the unprecedented global demand for therapies and treatments, and a race among wealthy nations to snap up supplies from treatment makers. In the U.S., the effort has focused buy water pills lasix on the extent to which the federal government has provided taxpayer dollars to different companies to help fund their discoveries. In some cases, advocates argue that federal funding matters because it clarifies the rights that the U.S. Government has to ensure a therapy or treatment is available to Americans on reasonable terms.One example has been remdesivir, the Gilead Sciences (GILD) treatment being given to buy water pills lasix hospitalized hypertension medications patients. The role played by the U.S.

Government in developing remdesivir to combat hypertensiones involved contributions from government personnel at such agencies buy water pills lasix as the U.S. Army Medical Research Institute of Infectious Diseases.As for the Moderna treatment, earlier this month, the company was awarded a $1.525 billion contract by the Department of Defense and the Department of Health and Human Services to manufacture and deliver 100 million doses of its hypertension medications treatment. The agreement also includes an option to purchase another 400 million doses, buy water pills lasix although the terms were not disclosed. In announcing the agreement, the government said it would ensure Americans receive the hypertension medications treatment at no cost, although they may be charged by health care providers for administering a shot.In this instance, however, Love said the “letter is not about price or profits. It’s about (Moderna) not owning buy water pills lasix up to DARPA funding inventions.

If the U.S. Wants to pay for all of the development of Moderna’s treatment, as Moderna now acknowledges, and throw in a few more billion now, and an option to spend billions more, it’s not unreasonable to have some transparency over who paid for their inventions.”This buy water pills lasix is not the first time Moderna has been accused of insufficient disclosure. Earlier this month, Knowledge Ecology International and Public Citizen maintained the company failed to disclose development costs in a $955 million contract awarded by BARDA for its hypertension medications treatment. In all, the federal government has awarded the company approximately $2.5 billion to develop the treatment.The coming few weeks represent a crucial moment for an ambitious plan to try to secure hypertension medications treatments for roughly 170 countries around the world without the deep pockets to compete for what will be scarce initial supplies.Under the plan, countries that want to pool resources to buy treatments must notify the World Health Organization and other organizers — Gavi, the buy water pills lasix treatment Alliance, as well as the Coalition for Epidemic Preparedness Innovations — of their intentions by Monday. That means it’s fish-or-cut-bait time for the so-called COVAX facility.Already, wealthy countries — the United States, the United Kingdom, Japan, Canada, and Australia, among others, as well as the European Union — have opted to buy their own treatment, signing bilateral contracts with manufacturers that have secured billions of doses of treatment already.

That raises the possibility that less wealthy countries will be boxed out buy water pills lasix of supplies.advertisement And yet Richard Hatchett, the CEO of CEPI, insists there is a path to billions of doses of treatment for the rest of the world in 2021. STAT spoke with Hatchett this week. A transcript of the conversation, lightly edited for buy water pills lasix clarity and length, follows. You said this is a critical time for CEPI. Can you explain what needs to happen between now and mid-September for this joint purchasing approach to be a success?.

Advertisement The critical moment is now for countries to commit to the COVAX facility, because that will enable us to secure ample quantities of treatment and then to buy water pills lasix be able to convey when that treatment is likely to become available based on current information.What we’re now here asking countries to do is to indicate their intent to participate by Aug. 31, and to make a binding commitment by Sept. 18. And to provide funds in support of that binding commitment by early October. Our negotiations with companies are already taking place and it will be important for us from a planning purpose that countries indicate their intent to participate.Those binding commitments we think will be sufficient to allow us to then secure the advance purchase agreements, particularly with those companies that don’t have a prior contractual obligation to COVAX.

And then obviously, we need the funds to live up to those advance purchase agreements.Is it possible this thing could still fall apart?. There appears to be some concern COVAX has been boxed out by rich countries. There was always a possibility that there wouldn’t be sufficient uptake. But I think we’re very encouraged at this point by the level of commitment, both from countries that would be beneficiaries of the advance market commitment — that’s the lower-income, lower-middle-income countries — as well as the self-financing countries. To have over 170 countries expressing interest in participating — they see the value.We’re much more encouraged now that it’s not going to fall apart.

We still need to bring it off to maximize its value. And we’re right at the crunch moment where countries are going to have to make these commitments. So, the next month is really absolutely critical to the facility. I am confident at this point that the world recognizes the value and wants it to work.I’ve been keeping tabs on advance purchase agreements that have been announced. And at this point, a small number of rich countries have nailed down a lot of treatment — more than 3 billion doses.

How hard does that make your job?. The fact that they’re doing it creates anxiety among other countries. And that in itself can accelerate the pace. So, I’m not going to say that we’re not watching that with concern.I will say that for COVAX and the facility, this is absolutely critical moment. I think we still have a window of opportunity between now and mid-September — when we’re asking that the self-financing countries to make their commitments — to make the facility real and to make it work.

Between doses that are committed to COVAX through the access agreements and other agreements — these are discussions with partners that CEPI has funded as well as partners that CEPI has not funded — we still see a pathway for COVAX to well over 3 billion doses in 2021.I think it’s really important to bear in mind is that there are at least a few countries — and I think the U.S. And the U.K. Most publicly — that may be in a situation of significant oversupply. I believe the U.S. And U.K.

Numbers, if you add them together, would result in enough treatment for 600 million people to receive two doses of treatment each. And, you know, there is no possible way that the U.S. Or the U.K. Can use that much treatment.So, there may be a lot of extra supply that looks like it’s been tied up sloshing around later. I don’t think that the bilateral deals that have been struck are going to prevent COVAX from achieving its goals.But if so much treatment has been pre-ordered by rich countries, can countries in the COVAX pool get enough for their needs?.

One of the things that we’ve argued through COVAX is that to control the lasix or to end the acute phase of the lasix to allow normalcy to start to reassert itself, you don’t have to vaccinate 100% of your population.You need to vaccinate those at greatest risk for bad outcomes and you need to vaccinate certain critical workers, particularly your health care workforce. And if you can achieve that goal, which for most countries means vaccinating between 20% and maybe 30% of the population, then you can transform the lasix into something that is much more manageable. Then you can buy yourself time to vaccinate everybody who wants to be vaccinated.We’ve argued the COVAX facility really offers the world the best shot at doing that globally in the fastest possible way, as well as providing for equitable access. This is a case where doing the equitable thing is also doing the efficient thing.CEPI has provided funding to nine treatments. Is it true that all those manufacturers aren’t required to provide the COVAX facility with treatment?.

That is correct. One of the things that we did, and I think it was an important role that CEPI played early on, was that we moved money very, very quickly, in small increments. You know, some of the early contracts were only $5 million or $10 million, to get programs up and running while we potentially put in place much larger-scale, longer-term contracts.If you were doing it over again, would you have given money without strings attached?. Yes, I think I would have. I think that was critically important to initiating programs.Our contract with Moderna was established in about 48 hours.

And that provided critical funding to them to manufacture doses that got them into clinical trials within nine weeks of the genetic sequences [of the hypertension lasix] being released.And if you look at the nine programs that we’ve invested in, seven are in clinical trials. Two — the AstraZeneca program now and the Moderna program — are among the handful in Phase 3 clinical trials. And, I think the number of projects that that we funded initially, which started in kind of a biotech or academic phase that have now been picked up by large multinational corporations, there’s at least four. The Themis program being picked up by Merck, Oxford University by AstraZeneca, the University of Queensland by CSL, and Clover being in partnership with GSK, I think that speaks to the quality of the programs that we selected.So, I think that combination of rapid review, speed of funding, getting those programs started, getting them oriented in the right direction, I think all of that is critical to where we are now.Companies that got money from CEPI to build out production capacity — that money came with strings attached, right?. Yes, exactly.

So, where CEPI has made investments that create manufacturing, or secure manufacturing capacity, the commitment has been that the capacity that is attributable to the CEPI investment is committed — at least right of first refusal — to the global procurement facility.WASHINGTON — The Trump administration removed a top Food and Drug Administration communications official from her post on Friday in the wake of several controversial agency misstatements, a senior administration official confirmed to STAT.The spokeswoman, Emily Miller, had played a lead role in defending the FDA commissioner, Stephen Hahn, after he misrepresented data regarding the use of blood plasma from recovered hypertension medications patients. The New York Times first reported Miller’s ouster. Miller’s tenure at as the top FDA spokeswoman lasted only 11 days. Her appointment was viewed with alarm by agency officials who felt her presence at the agency was emblematic of broader political pressure from the Trump administration, STAT first reported earlier this week.advertisement Before joining the FDA, Miller had no experience in health or medicine. Her former role as assistant commissioner for media affairs is typically not an appointment filled by political appointees.

The FDA’s communications arm typically maintains a neutral, nonpolitical tone.Miller’s appointment particularly alarmed FDA staff and outside scientists given her history in right-wing political advocacy and conservatism journalism. Her résumé included a stint as a Washington Times columnist, where she penned columns with titles that include “New Obamacare ads make young women look like sluts,” and a 2013 book on gun rights titled “Emily Gets Her Gun. But Obama Wants to Take Yours.”advertisement She also worked as a reporter for One America News Network, a right-wing cable channel that frequently espouses conspiracy theories and has declared an open alliance with President Trump.Miller quickly made her presence known at the FDA. In the wake of Hahn’s misstatements on blood plasma, she aggressively defended the commissioner, falsely claiming in a tweet that the therapy “has shown to be beneficial for 35% of patients.” An FDA press release on blood plasma, issued less than a week after her appointment, similarly alarmed agency insiders by trumpeting the emergency authorization as “Another Achievement in Administration’s Fight Against [the] lasix.”.